Provider Demographics
NPI:1417187121
Name:CHRISTOPHER, TERRY MATTHEW (DC)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:MATTHEW
Last Name:CHRISTOPHER
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 1:410 SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40769-1137
Mailing Address - Country:US
Mailing Address - Phone:606-549-4811
Mailing Address - Fax:606-549-4814
Practice Address - Street 1:412 SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:KY
Practice Address - Zip Code:40769-1137
Practice Address - Country:US
Practice Address - Phone:606-549-4811
Practice Address - Fax:606-549-4814
Is Sole Proprietor?:No
Enumeration Date:2009-07-16
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3480111N00000X
KY5204111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100090870Medicaid