Provider Demographics
NPI:1336270420
Name:LAMBERT, TERRANCE M (DC)
Entity Type:Individual
Prefix:DR
First Name:TERRANCE
Middle Name:M
Last Name:LAMBERT
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 1:4366 LIBERTY SQ SW
Mailing Address - Street 2:
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49418-2470
Mailing Address - Country:US
Mailing Address - Phone:616-301-3800
Mailing Address - Fax:
Practice Address - Street 1:5300 NORTHLAND DR NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-1058
Practice Address - Country:US
Practice Address - Phone:616-361-7810
Practice Address - Fax:616-361-0036
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITL005273111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOD15011Medicare ID - Type Unspecified
MIT32981Medicare UPIN