Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | IL |
NPI | 1053457432 |
---|---|
Provider Name | Dr. Sam H Terbeek |
First Address | Galesburg, IL 61401-6632 |
Second Address | Galesburg, IL 61401-6632 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2007 |
Last Update Date | 08/07/2007 |