Provider Demographics
NPI:1861694457
Name:VANDYKE, ROY NEIL (DC)
Entity type:Individual
Prefix:DR
First Name:ROY
Middle Name:NEIL
Last Name:VANDYKE
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 1:6220 CASTLECOVE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-6643
Mailing Address - Country:US
Mailing Address - Phone:704-778-3729
Mailing Address - Fax:
Practice Address - Street 1:11709 FRUEHAUF DR STE 101
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273
Practice Address - Country:US
Practice Address - Phone:980-209-0932
Practice Address - Fax:980-209-0962
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2019-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005453111N00000X
SC3104111N00000X
NC3465111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor