Organization
SOUTHEAST CHIROPRACTIC INCORPORATED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KELLY D TERRY D.C. (OWNER)
(435) 637-4621
Entity
Organization
Contact information
Practice address
55 N 600 E, PRICE, UT 84501-2624
(435) 637-4621
Mailing address
55 N 600 E, PRICE, UT 84501-2624
(435) 637-4621
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
359704-1202
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
46643
ALTIUS HEALTH PLANS
UT
01
—
50915
PEHP
—
05
—
530545403012
—
UT
01
—
53054540377001
BLUE CROSS BLUE SHIELD/CH
—
01
—
870395551TE5
EDUCATORS
—
Enumeration date
07/13/2007
Last updated
10/18/2007
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