Provider Demographics
NPI:1750457487
Name:KAHN, TERRY L (DC)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:L
Last Name:KAHN
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 1:4606 S CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE 1M
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-6404
Mailing Address - Country:US
Mailing Address - Phone:386-756-9303
Mailing Address - Fax:386-756-8119
Practice Address - Street 1:4606 S CLYDE MORRIS BLVD
Practice Address - Street 2:SUITE 1M
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32129-6404
Practice Address - Country:US
Practice Address - Phone:386-756-9303
Practice Address - Fax:386-756-8119
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMCO2661111N00000X
FLCH9244111N00000X
TX10110111N00000X
LA1381111N00000X
VA465111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000865400Medicaid
FLBJ943Medicare PIN