Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 003718 | MO |
N | 111NS0005X | Chiropractic Sports Physician | 003718 | MO |
NPI | 1245265305 |
---|---|
Provider Name | Dr. Terry Aurthur Surtin |
First Address | Saint Peters, MO 63376-6410 |
Second Address | Saint Peters, MO 63376-6410 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 10/11/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
109916 | HEALTHLINK (01) | MO |
28169 | BLUE CROSS BLUE SHIELD (01) | MO |
391886617 | TRIAD (01) | MO |
4400388 | UNITED HEALTHCARE (01) | MO |
T43208 | (02) | MO |