Provider Demographics
NPI:1912201674
Name:VANDYKE, KATHERINE MARYANN (DC)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MARYANN
Last Name:VANDYKE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 N MAIN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-1625
Mailing Address - Country:US
Mailing Address - Phone:830-331-8600
Mailing Address - Fax:
Practice Address - Street 1:801 N MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-1625
Practice Address - Country:US
Practice Address - Phone:830-331-8600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-10
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11352111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor