Provider Demographics
NPI:1689963084
Name:TERRY FAMILY CHIROPRACTIC, INC.
Entity type:Organization
Organization Name:TERRY FAMILY CHIROPRACTIC, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:D
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-302-0660
Mailing Address - Street 1:3898 INNOVATION DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-6037
Mailing Address - Country:US
Mailing Address - Phone:801-302-0660
Mailing Address - Fax:801-302-2239
Practice Address - Street 1:3898 INNOVATION DR
Practice Address - Street 2:SUITE B
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-6037
Practice Address - Country:US
Practice Address - Phone:801-302-0660
Practice Address - Fax:801-302-2239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty