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Individual
KELLY DURWARD TERRY
Active
Individual
KELLY DURWARD TERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
359704-1202
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
46643
ALTIUS THRU CHP
UT
01
—
50915
PEHP FOR CHP
UT
05
—
870395551019
—
UT
01
—
870395551TE5
EDUCATORS MUTUAL
UT
Enumeration date
08/13/2006
Last updated
03/12/2013
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