Provider Demographics
NPI:1609933035
Name:TERRY A. SURTIN, D.C. P.C.
Entity Type:Organization
Organization Name:TERRY A. SURTIN, D.C. P.C.
Other - Org Name:CAVE SPRINGS CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:AURTHUR
Authorized Official - Last Name:SURTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:636-441-5700
Mailing Address - Street 1:4127 MEXICO RD
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-6410
Mailing Address - Country:US
Mailing Address - Phone:636-441-5700
Mailing Address - Fax:636-441-7784
Practice Address - Street 1:4127 MEXICO RD
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-6410
Practice Address - Country:US
Practice Address - Phone:636-441-5700
Practice Address - Fax:636-441-7784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO003718111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO109916OtherHEALTHLINK
MO4400388OtherUNITED HEALTHCARE
MO28169OtherBLUE CROSS BLUE SHIELD
MO391886617OtherTRIAD
MO391886617OtherTRIAD
MOT43208Medicare UPIN