Provider Demographics
NPI:1295845071
Name:TERRY, BRUCE JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:JOSEPH
Last Name:TERRY
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 1:5877 LAMPSON AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92845
Mailing Address - Country:US
Mailing Address - Phone:714-899-0103
Mailing Address - Fax:
Practice Address - Street 1:5877 LAMPSON AVE
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92845
Practice Address - Country:US
Practice Address - Phone:714-899-0103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC17514111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC17514Medicare ID - Type Unspecified
T18557Medicare UPIN