Provider Demographics
NPI:1235779661
Name:TERVEER, KAMRYN DONNA (DC)
Entity Type:Individual
Prefix:
First Name:KAMRYN
Middle Name:DONNA
Last Name:TERVEER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3525 S WATER TOWER PL APT 242
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-6776
Mailing Address - Country:US
Mailing Address - Phone:618-830-6924
Mailing Address - Fax:
Practice Address - Street 1:140 S MILL ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:IL
Practice Address - Zip Code:62263-1831
Practice Address - Country:US
Practice Address - Phone:618-327-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-14
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.013499111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor