Provider Demographics
NPI:1457570558
Name:VAN DER MERWE, KATINKA (DC)
Entity Type:Individual
Prefix:DR
First Name:KATINKA
Middle Name:
Last Name:VAN DER MERWE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:KATINKA
Other - Middle Name:
Other - Last Name:CONNORS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:22 W COLT SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-2813
Mailing Address - Country:US
Mailing Address - Phone:479-582-5900
Mailing Address - Fax:479-582-0569
Practice Address - Street 1:124 W SUNBRIDGE DR
Practice Address - Street 2:SUITE 7
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-1869
Practice Address - Country:US
Practice Address - Phone:479-582-5900
Practice Address - Fax:479-582-0569
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1540111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5X154Medicare PIN