Provider Demographics
NPI:1295872182
Name:SMITH, TERRY C (DC)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:C
Last Name:SMITH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:5698 S US HIGHWAY 85-87
Mailing Address - Street 2:STE 110
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80911-1465
Mailing Address - Country:US
Mailing Address - Phone:719-390-5404
Mailing Address - Fax:719-390-8313
Practice Address - Street 1:5698 S US HIGHWAY 85-87
Practice Address - Street 2:STE 110
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80911-1465
Practice Address - Country:US
Practice Address - Phone:719-390-5404
Practice Address - Fax:719-390-8313
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3228111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC26813Medicare PIN
COC811838Medicare PIN