Healthcare Provider Details

I. General information

NPI: 1003852633
Provider Name (Legal Business Name): SETRAK TERZIAN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: SETRO TERZIAN DC

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 03/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

585 W COLLEGE AVE SUITE B
SANTA ROSA CA
95401-5000
US

IV. Provider business mailing address

585 W COLLEGE AVE SUITE B
SANTA ROSA CA
95401-5000
US

V. Phone/Fax

Practice location:
  • Phone: 707-583-9077
  • Fax:
Mailing address:
  • Phone: 707-583-9077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License NumberDC28916
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC28916
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: