Provider Demographics
NPI:1386709632
Name:TERRELL CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:TERRELL CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:BYNUM
Authorized Official - Last Name:TERRELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:256-638-9393
Mailing Address - Street 1:PO BOX 1757
Mailing Address - Street 2:
Mailing Address - City:RAINSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35986-1757
Mailing Address - Country:US
Mailing Address - Phone:256-638-9393
Mailing Address - Fax:256-638-9395
Practice Address - Street 1:65 MCCURDY AVE SOUTH
Practice Address - Street 2:
Practice Address - City:RAINSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35986
Practice Address - Country:US
Practice Address - Phone:256-638-9393
Practice Address - Fax:256-638-9395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2001111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALU84217Medicare UPIN