Provider Demographics
NPI:1053457432
Name:TERBEEK, SAM H (DC)
Entity Type:Individual
Prefix:DR
First Name:SAM
Middle Name:H
Last Name:TERBEEK
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 1:2515 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401-6632
Mailing Address - Country:US
Mailing Address - Phone:309-342-0919
Mailing Address - Fax:309-342-7520
Practice Address - Street 1:2515 GRAND AVE
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-6632
Practice Address - Country:US
Practice Address - Phone:309-342-1717
Practice Address - Fax:309-342-7520
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition