Provider Demographics
NPI:1184708950
Name:TERYL, THOMAS H (DC)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:H
Last Name:TERYL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1912 TEXAS ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-4442
Mailing Address - Country:US
Mailing Address - Phone:707-425-4627
Mailing Address - Fax:707-425-2960
Practice Address - Street 1:1912 TEXAS ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-4442
Practice Address - Country:US
Practice Address - Phone:707-425-4627
Practice Address - Fax:707-425-2960
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19302111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor