Provider Demographics
NPI:1669511952
Name:EYERLY, TERRANCE MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:TERRANCE
Middle Name:MICHAEL
Last Name:EYERLY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 BUTLER DR
Mailing Address - Street 2:PO BOX 2279
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18201-7363
Mailing Address - Country:US
Mailing Address - Phone:570-455-5822
Mailing Address - Fax:570-455-5053
Practice Address - Street 1:110 BUTLER DR
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-7363
Practice Address - Country:US
Practice Address - Phone:570-455-5822
Practice Address - Fax:570-455-5053
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC 1499-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT29866Medicare UPIN
PA167875Medicare ID - Type Unspecified