Provider Demographics
NPI:1801939830
Name:TERRAY, AMY LOUISE (DC)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:LOUISE
Last Name:TERRAY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:17 PINE TREE DR
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-3217
Mailing Address - Country:US
Mailing Address - Phone:203-488-4789
Mailing Address - Fax:860-395-1113
Practice Address - Street 1:1381 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475-1700
Practice Address - Country:US
Practice Address - Phone:860-388-2199
Practice Address - Fax:860-395-1113
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001340111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTU79657Medicare UPIN