Provider Demographics
NPI:1003852633
Name:TERZIAN, SETRAK (DC)
Entity type:Individual
Prefix:DR
First Name:SETRAK
Middle Name:
Last Name:TERZIAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:SETRO
Other - Middle Name:
Other - Last Name:TERZIAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:585 W COLLEGE AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-5000
Mailing Address - Country:US
Mailing Address - Phone:707-583-9077
Mailing Address - Fax:
Practice Address - Street 1:585 W COLLEGE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-5000
Practice Address - Country:US
Practice Address - Phone:707-583-9077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28916111NR0200X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0200XChiropractic ProvidersChiropractorRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0289160Medicare PIN