Provider Demographics
NPI:1760554539
Name:TROMBLEY, TERRY DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:DAVID
Last Name:TROMBLEY
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 1:5671 N SKEEL
Mailing Address - Street 2:
Mailing Address - City:OSCODA
Mailing Address - State:MI
Mailing Address - Zip Code:48750
Mailing Address - Country:US
Mailing Address - Phone:989-739-0077
Mailing Address - Fax:989-739-2743
Practice Address - Street 1:5671 N SKEEL
Practice Address - Street 2:
Practice Address - City:OSCODA
Practice Address - State:MI
Practice Address - Zip Code:48750
Practice Address - Country:US
Practice Address - Phone:989-739-0077
Practice Address - Fax:989-739-2743
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301006829111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
950C55002OtherBLUE CROSS
MIP78051OtherBLUE CARE NETWORK
T92747Medicare UPIN
950C55002OtherBLUE CROSS