Provider Demographics
NPI:1801881925
Name:ANDERSON, TERA HAMO (DC)
Entity type:Individual
Prefix:DR
First Name:TERA
Middle Name:HAMO
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:TERA
Other - Middle Name:KAY
Other - Last Name:HAMO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1174 W HILL RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-4776
Mailing Address - Country:US
Mailing Address - Phone:810-238-9066
Mailing Address - Fax:810-238-9139
Practice Address - Street 1:1174 W HILL RD
Practice Address - Street 2:SUITE 2
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-4776
Practice Address - Country:US
Practice Address - Phone:810-238-9066
Practice Address - Fax:810-238-9139
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008899111N00000X
IA3994111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P18830Medicare PIN