Provider Demographics
NPI:1245265305
Name:SURTIN, TERRY AURTHUR (DC)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:AURTHUR
Last Name:SURTIN
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 1:4127 MEXICO RD
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-6410
Mailing Address - Country:US
Mailing Address - Phone:636-441-5700
Mailing Address - Fax:636-441-7784
Practice Address - Street 1:4127 MEXICO RD
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-6410
Practice Address - Country:US
Practice Address - Phone:636-441-5700
Practice Address - Fax:636-441-7784
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO003718111N00000X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO391886617OtherTRIAD
MO4400388OtherUNITED HEALTHCARE
MO28169OtherBLUE CROSS BLUE SHIELD
MO109916OtherHEALTHLINK
MO000030503Medicare PIN
MO109916OtherHEALTHLINK