Healthcare Provider Details

I. General information

NPI: 1720129695
Provider Name (Legal Business Name): TERRELL G KLEMA DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 10/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

296 MAIN ST.
CHARLESTOWN NH
03603-0077
US

IV. Provider business mailing address

296 MAIN ST., PO BOX 77
CHARLESTOWN NH
03603-0077
US

V. Phone/Fax

Practice location:
  • Phone: 603-826-5220
  • Fax: 603-826-5220
Mailing address:
  • Phone: 603-826-5220
  • Fax: 603-826-5220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5950200
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: