Provider Demographics
NPI:1033309976
Name:FLOCK, TERRELL ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:TERRELL
Middle Name:ALLEN
Last Name:FLOCK
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 1:1233 E LIGHTHOUSE CT
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2639
Mailing Address - Country:US
Mailing Address - Phone:602-319-7664
Mailing Address - Fax:
Practice Address - Street 1:1233 E LIGHTHOUSE CT
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2639
Practice Address - Country:US
Practice Address - Phone:602-319-7664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7035111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor