Provider Demographics
NPI:1235289075
Name:TERRELL, ERIC DOUGLAS (DC)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:DOUGLAS
Last Name:TERRELL
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 1:3541 CHAIN BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-2793
Mailing Address - Country:US
Mailing Address - Phone:703-691-2225
Mailing Address - Fax:
Practice Address - Street 1:3541 CHAIN BRIDGE RD
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2793
Practice Address - Country:US
Practice Address - Phone:703-691-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000794111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAFO55OOO1OtherCAREFIRST
VA54-1829779OtherTAX ID
VA4227400OtherAETNA
VA220381OtherANTHEM
VA440125OtherUNITED HEALTHCARE
VAS5767OtherINOVATION HEALTH
VAFO55OOO1OtherCAREFIRST
VAT84780Medicare UPIN