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General NPI Number Information
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NPI Number | 1255616785
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Entity Type | Organization
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Legal Business Name | NEUROLOGIC RELIEF CENTER PLLC
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Dates
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Enumeration Date | 10/16/2011
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Last Update Date | 09/30/2021
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Provider Practice Location Address
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Address Line | 22 W COLT SQUARE DR
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-2813
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Country | US
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Telephone | 479-582-5900
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Fax | 479-582-0569
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Provider Business Mailing Address
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Address Line | 22 W COLT SQUARE DR
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-2813
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KATINKA VAN DER MERWE
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Credential |
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Telephone | 479-582-5900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 1540
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | E-1940
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License Number State | AR
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