Provider Demographics
NPI:1730562422
Name:VANDENBERG, JONATHAN CHRISTIAN (DO)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:CHRISTIAN
Last Name:VANDENBERG
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1331 MOURSUND AVENUE
Mailing Address - Street 2:BLDG. G RM 115-118
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-5389
Mailing Address - Country:US
Mailing Address - Phone:713-799-5033
Mailing Address - Fax:713-797-5982
Practice Address - Street 1:235 WEALTHY ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-5247
Practice Address - Country:US
Practice Address - Phone:616-840-8805
Practice Address - Fax:616-840-9642
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-30
Last Update Date:2021-03-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101025744208100000X
IL125.066293208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation