MEDICARE: DR. TERRY OVERTON D.C.

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	111NS0005X	Sports Physician Chiropractor	7175	TX

General Provider Information

NPI Number	:	1245276138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERRY OVERTON D.C.

Provider Business Mailing Address
First Line	:	1006 CENTRAL PKWY S
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-5021
Country	:	US
Telephone Number	:	210-490-9169
Fax Number	:	210-545-7740

Provider Business Practice Location Address
First Line	:	1006 CENTRAL PKWY S
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-5021
Country	:	US
Telephone Number	:	210-490-9169
Fax Number	:	210-545-7740

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

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	07/08/2007

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