Provider Demographics
NPI:1225359730
Name:TERRY CHIROPRACTIC, PS
Entity Type:Organization
Organization Name:TERRY CHIROPRACTIC, PS
Other - Org Name:TRI-CITIES BODYWORKS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:509-713-4204
Mailing Address - Street 1:2568 QUEENSGATE DR
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-9109
Mailing Address - Country:US
Mailing Address - Phone:509-713-4204
Mailing Address - Fax:509-343-2907
Practice Address - Street 1:2568 QUEENSGATE DR
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-9109
Practice Address - Country:US
Practice Address - Phone:509-713-4204
Practice Address - Fax:509-343-2907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-18
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034327111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty