Provider Demographics
NPI:1407168867
Name:TERRY, RUSSELL D (DC)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:D
Last Name:TERRY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3898 INNOVATION DR
Mailing Address - Street 2:STE B
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-6037
Mailing Address - Country:US
Mailing Address - Phone:801-302-0660
Mailing Address - Fax:801-302-2239
Practice Address - Street 1:3898 INNOVATION DR
Practice Address - Street 2:STE B
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-6037
Practice Address - Country:US
Practice Address - Phone:801-302-0660
Practice Address - Fax:801-302-2239
Is Sole Proprietor?:No
Enumeration Date:2010-07-13
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7719074-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor