Provider Demographics
NPI:1417251646
Name:GATTON, TERRI DARLENE (DC)
Entity Type:Individual
Prefix:DR
First Name:TERRI
Middle Name:DARLENE
Last Name:GATTON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 GOODMAN RD E
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-5104
Mailing Address - Country:US
Mailing Address - Phone:662-470-4767
Mailing Address - Fax:662-470-4675
Practice Address - Street 1:1330 GOODMAN RD E STE 1
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-5104
Practice Address - Country:US
Practice Address - Phone:662-470-4764
Practice Address - Fax:662-470-4675
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-03
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1168111N00000X
TN2457111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor