Provider Demographics
NPI:1720478126
Name:TERZENBACH, HEIDI MARIE (LMP)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:MARIE
Last Name:TERZENBACH
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3205 S UNIVERSITY RD APT 60
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-5866
Mailing Address - Country:US
Mailing Address - Phone:509-370-8140
Mailing Address - Fax:
Practice Address - Street 1:20 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-6221
Practice Address - Country:US
Practice Address - Phone:509-484-7578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-23
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60504395111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation