Provider Demographics
NPI:1922168871
Name:TERRY, CHRISTOPHER LEE (DC)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:LEE
Last Name:TERRY
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 1:500 SUNNY RD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801
Mailing Address - Country:US
Mailing Address - Phone:863-640-5344
Mailing Address - Fax:813-374-8929
Practice Address - Street 1:4602 NORTH ARMENIA AVE
Practice Address - Street 2:BUILDING D-3
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603
Practice Address - Country:US
Practice Address - Phone:813-350-9100
Practice Address - Fax:813-374-8929
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9307111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL382132300Medicaid
FL76109OtherBCBS
FL76109ZMedicare PIN