Provider Demographics
NPI:1790820777
Name:SROKOSE, TERRENCE (DC)
Entity Type:Individual
Prefix:
First Name:TERRENCE
Middle Name:
Last Name:SROKOSE
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 1:82 PALOMINO LN
Mailing Address - Street 2:SUITE 501
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6448
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:89 DOW ST
Practice Address - Street 2:GOLD'S GYM
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-1210
Practice Address - Country:US
Practice Address - Phone:603-606-4993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH7481005111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAV04942Medicare UPIN