Provider Demographics
NPI:1629280243
Name:FLEMING, TERRA RAE (DC)
Entity Type:Individual
Prefix:DR
First Name:TERRA
Middle Name:RAE
Last Name:FLEMING
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 1:12060 JUNIPER ST NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55448-2279
Mailing Address - Country:US
Mailing Address - Phone:763-413-1085
Mailing Address - Fax:
Practice Address - Street 1:12060 JUNIPER ST NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55448-2279
Practice Address - Country:US
Practice Address - Phone:763-413-1085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2947111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN718328300Medicaid
MN718328300Medicaid