Provider Demographics
NPI:1134298797
Name:MCDONALD, TERRANCE JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:TERRANCE
Middle Name:JOSEPH
Last Name:MCDONALD
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 1:351 N 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52245-3618
Mailing Address - Country:US
Mailing Address - Phone:319-338-7597
Mailing Address - Fax:319-338-7598
Practice Address - Street 1:351 N 1ST AVE
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-3618
Practice Address - Country:US
Practice Address - Phone:319-338-7597
Practice Address - Fax:319-338-7598
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA04747111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1174581Medicaid
IAT01011Medicare UPIN
IAIA00333Medicare ID - Type Unspecified