Provider Demographics
NPI:1407956261
Name:WILEY, TERRY L (DC)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:L
Last Name:WILEY
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 1:511 MAIN ST STE 6
Mailing Address - Street 2:
Mailing Address - City:ALAMOSA
Mailing Address - State:CO
Mailing Address - Zip Code:81101-2649
Mailing Address - Country:US
Mailing Address - Phone:719-589-5163
Mailing Address - Fax:719-589-8988
Practice Address - Street 1:511 MAIN ST., SUITE #6
Practice Address - Street 2:
Practice Address - City:ALAMOSA
Practice Address - State:CO
Practice Address - Zip Code:81101-2664
Practice Address - Country:US
Practice Address - Phone:719-589-5163
Practice Address - Fax:719-589-8988
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1181111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition