Provider Demographics
NPI:1962756874
Name:TERNOIR, MATHEW JOHN (DC)
Entity type:Individual
Prefix:DR
First Name:MATHEW
Middle Name:JOHN
Last Name:TERNOIR
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 1:8110 W SUMMERDALE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60656-1556
Mailing Address - Country:US
Mailing Address - Phone:708-328-9070
Mailing Address - Fax:
Practice Address - Street 1:2114 45TH ST
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-3742
Practice Address - Country:US
Practice Address - Phone:219-924-7525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002683A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor