Provider Demographics
NPI:1306849203
Name:SELLERS, TERRY L (D C)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:L
Last Name:SELLERS
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 OZARK DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:CUBA
Mailing Address - State:MO
Mailing Address - Zip Code:65453-1664
Mailing Address - Country:US
Mailing Address - Phone:573-885-1470
Mailing Address - Fax:573-885-1471
Practice Address - Street 1:102 OZARK DR
Practice Address - Street 2:SUITE A
Practice Address - City:CUBA
Practice Address - State:MO
Practice Address - Zip Code:65453-1664
Practice Address - Country:US
Practice Address - Phone:573-885-1470
Practice Address - Fax:573-885-1471
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000167298111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO350053003OtherRAILROAD RETIREMENT MEDIC
MO43-1890960OtherP.H.C.S.
MO1905114OtherFIRST HEALTH
MO43-1890960OtherA.C.N.
MO44-00099OtherUNITED HEALTH CARE
MO442512OtherHEALTH LINK
MO131519OtherBLUE CROSS
MO44-00099OtherUNITED HEALTH CARE
MO000031848Medicare PIN