Provider Demographics
NPI:1821697087
Name:TERRY, LEWIS TADD (DC)
Entity Type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:TADD
Last Name:TERRY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:TADD
Other - Middle Name:
Other - Last Name:TERRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:670 N 54TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-1529
Mailing Address - Country:US
Mailing Address - Phone:480-701-8201
Mailing Address - Fax:480-701-8201
Practice Address - Street 1:670 N 54TH ST STE 1
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-1529
Practice Address - Country:US
Practice Address - Phone:480-701-8201
Practice Address - Fax:480-701-8201
Is Sole Proprietor?:No
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8953111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor