Provider Demographics
NPI:1760663231
Name:TERRY CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:TERRY CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:H
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-886-3118
Mailing Address - Street 1:9905 OLD SAINT AUGUSTINE RD STE 504
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-8856
Mailing Address - Country:US
Mailing Address - Phone:904-886-3118
Mailing Address - Fax:904-886-3119
Practice Address - Street 1:9905 OLD SAINT AUGUSTINE RD STE 504
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-8856
Practice Address - Country:US
Practice Address - Phone:904-886-3118
Practice Address - Fax:904-886-3119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-26
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0004235111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
88096AMedicare PIN