MEDICARE: JUSTIN TERRY DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CHR.0008404	CO

General Provider Information

NPI Number	:	1154084283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN TERRY DC

Provider Business Mailing Address
First Line	:	5350 W OLD SHAKOPEE CIR
Second Line	:
City	:	BLOOMINGTON
State	:	MN
Zip	:	55437-2769
Country	:	US
Telephone Number	:	651-443-2793
Fax Number	:

Provider Business Practice Location Address
First Line	:	5350 W OLD SHAKOPEE CIR
Second Line	:
City	:	BLOOMINGTON
State	:	MN
Zip	:	55437-2769
Country	:	US
Telephone Number	:	651-443-2793
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2021
Last Update Date	:	10/15/2021

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Directions to “ JUSTIN TERRY DC” Practice Location

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