Provider Demographics
NPI:1043779523
Name:KEITH A TERRO II DC LLC
Entity Type:Organization
Organization Name:KEITH A TERRO II DC LLC
Other - Org Name:TERRO SPINE AND SPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:TERRO
Authorized Official - Suffix:II
Authorized Official - Credentials:DC, CCSP
Authorized Official - Phone:337-443-9300
Mailing Address - Street 1:224 SAINT LANDRY ST STE 2A
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-3549
Mailing Address - Country:US
Mailing Address - Phone:337-443-9300
Mailing Address - Fax:337-443-9311
Practice Address - Street 1:224 SAINT LANDRY ST STE 2A
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-3549
Practice Address - Country:US
Practice Address - Phone:337-443-9300
Practice Address - Fax:337-443-9311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-14
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1417OtherSTATE LICENSE NUMBER