Provider Demographics
NPI:1740314160
Name:TERRY, WILLIAM K (DC)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:K
Last Name:TERRY
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 1:9905 OLD SAINT AUGUSTINE RD STE 504
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-8856
Mailing Address - Country:US
Mailing Address - Phone:904-886-3118
Mailing Address - Fax:904-886-3119
Practice Address - Street 1:9905 OLD SAINT AUGUSTINE RD STE 504
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-8856
Practice Address - Country:US
Practice Address - Phone:904-886-3118
Practice Address - Fax:904-886-3119
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0004235111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6908Medicare UPIN
FL88096AMedicare ID - Type Unspecified