Provider Demographics
NPI:1720135817
Name:NACHWOSTACH, TERRY LEON (DC)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:LEON
Last Name:NACHWOSTACH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:TARAS
Other - Middle Name:LEON
Other - Last Name:NACHWOSTACH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:111 ROCHDALE
Mailing Address - Street 2:SUITE B
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307
Mailing Address - Country:US
Mailing Address - Phone:248-652-8686
Mailing Address - Fax:
Practice Address - Street 1:111 ROCHDALE
Practice Address - Street 2:SUITE B
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307
Practice Address - Country:US
Practice Address - Phone:248-652-8686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-002527L111N00000X
MI2301004290111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PANA198764Medicare ID - Type UnspecifiedMEDICARE