Provider Demographics
NPI:1649378555
Name:CREAMEAN, TERRY LEE
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:LEE
Last Name:CREAMEAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 W HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:IL
Mailing Address - Zip Code:61764-1603
Mailing Address - Country:US
Mailing Address - Phone:815-844-3803
Mailing Address - Fax:
Practice Address - Street 1:820 W HOWARD ST
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:IL
Practice Address - Zip Code:61764-1603
Practice Address - Country:US
Practice Address - Phone:815-844-3803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-009217111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038009217Medicaid
IL038009217Medicaid