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NPI Code Detail

MEDICARE: DR. MARK J TERRELL D.C.

MEDICARE: DR. MARK J TERRELL 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
1111N00000XChiropractor1014OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
131-1084409-00OTHEROHBWC PROVIDER NUMBER
2000000010457OTHEROHANTHEM PIN NUMBER

General Provider Information

NPI Number : 1568509875
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARK J TERRELL D.C.
Provider Business Mailing Address
First Line : 1930 N LIMESTONE ST
Second Line :
City : SPRINGFIELD
State : OH
Zip : 45503-2648
Country : US
Telephone Number : 937-390-6403
Fax Number : 937-390-2763
Provider Business Practice Location Address
First Line : 1930 N LIMESTONE ST
Second Line :
City : SPRINGFIELD
State : OH
Zip : 45503-2648
Country : US
Telephone Number : 937-390-6403
Fax Number : 937-390-2763
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2007
Last Update Date : 07/09/2007

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