Provider Demographics
NPI:1710906193
Name:TOLBIRT, TERRANCE (DC)
Entity Type:Individual
Prefix:
First Name:TERRANCE
Middle Name:
Last Name:TOLBIRT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:TERRY
Other - Middle Name:
Other - Last Name:TOLBIRT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 5502
Mailing Address - Street 2:
Mailing Address - City:BLUE JAY
Mailing Address - State:CA
Mailing Address - Zip Code:92317-5502
Mailing Address - Country:US
Mailing Address - Phone:909-336-1487
Mailing Address - Fax:
Practice Address - Street 1:27248 HIGHWAY 189
Practice Address - Street 2:SUITE 7
Practice Address - City:BLUE JAY
Practice Address - State:CA
Practice Address - Zip Code:92317-5502
Practice Address - Country:US
Practice Address - Phone:909-336-1487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21144111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0211440Medicare ID - Type Unspecified
CAU20471Medicare UPIN