Healthcare Provider Details

I. General information

NPI: 1609933035
Provider Name (Legal Business Name): TERRY A. SURTIN, D.C. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 11/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4127 MEXICO RD
SAINT PETERS MO
63376-6410
US

IV. Provider business mailing address

4127 MEXICO RD
SAINT PETERS MO
63376-6410
US

V. Phone/Fax

Practice location:
  • Phone: 636-441-5700
  • Fax: 636-441-7784
Mailing address:
  • Phone: 636-441-5700
  • Fax: 636-441-7784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number003718
License Number StateMO

VIII. Authorized Official

Name: DR. TERRY AURTHUR SURTIN
Title or Position: OWNER
Credential: DC
Phone: 636-441-5700