Provider Demographics
NPI:1700107653
Name:BEDNAR, TERRI LYNN (DC)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:LYNN
Last Name:BEDNAR
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N UNION ST
Mailing Address - Street 2:
Mailing Address - City:YATES CITY
Mailing Address - State:IL
Mailing Address - Zip Code:61572-9344
Mailing Address - Country:US
Mailing Address - Phone:309-224-4701
Mailing Address - Fax:
Practice Address - Street 1:400 N UNION ST
Practice Address - Street 2:
Practice Address - City:YATES CITY
Practice Address - State:IL
Practice Address - Zip Code:61572-9344
Practice Address - Country:US
Practice Address - Phone:309-224-4701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-15
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.011706111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor