Provider Demographics
NPI:1043423783
Name:COTTRELL, TERRY WILLARD (DC)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:WILLARD
Last Name:COTTRELL
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 1:6520 226TH PL SE
Mailing Address - Street 2:SUITE# 203
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-8969
Mailing Address - Country:US
Mailing Address - Phone:425-392-9490
Mailing Address - Fax:425-427-6401
Practice Address - Street 1:140 6TH AVE NE
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-3341
Practice Address - Country:US
Practice Address - Phone:425-392-9490
Practice Address - Fax:425-427-6401
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002014111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACH00002014OtherCHIROPRACTIC LICENSE