Provider Demographics
NPI:1609996495
Name:SCHWADERER, TERRI ANNE (LAC LICENSED ACUPUNC)
Entity Type:Individual
Prefix:MS
First Name:TERRI
Middle Name:ANNE
Last Name:SCHWADERER
Suffix:
Gender:F
Credentials:LAC LICENSED ACUPUNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 E CAMPBELL AVE
Mailing Address - Street 2:SUITE 16B
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-2138
Mailing Address - Country:US
Mailing Address - Phone:408-378-0547
Mailing Address - Fax:408-378-5124
Practice Address - Street 1:621 E CAMPBELL AVE
Practice Address - Street 2:SUITE 16B
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008
Practice Address - Country:US
Practice Address - Phone:408-378-0547
Practice Address - Fax:408-378-5124
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC4180171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist