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General NPI Number Information
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NPI Number | 1962544726
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Entity Type | Individual
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Provider Name | TERRY GLEN SMITH D.C.
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Gender | Male
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 03/02/2015
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Provider Practice Location Address
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Address Line | 379 AVENUE OF THE CITIES
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City | EAST MOLINE
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State | IL
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Zip | 61244-4023
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Country | US
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Telephone | 309-752-1410
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Fax |
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Provider Business Mailing Address
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Address Line | 379 AVENUE OF THE CITIES
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City | EAST MOLINE
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State | IL
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Zip | 61244-4023
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Country | US
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Telephone | 309-752-1410
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 038-006661
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License Number State | IL
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