Provider Demographics
NPI:1679984504
Name:VANDERLOO, NATHAN (DC)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:
Last Name:VANDERLOO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4462 BRETON RD SE
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49508-5272
Mailing Address - Country:US
Mailing Address - Phone:616-827-2225
Mailing Address - Fax:616-827-2820
Practice Address - Street 1:4462 BRETON RD SE
Practice Address - Street 2:
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49508-5272
Practice Address - Country:US
Practice Address - Phone:616-827-2225
Practice Address - Fax:616-827-2820
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-13
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010210111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor