Provider Demographics
NPI:1447024005
Name:TERAVEST, SY LOUIS (DC)
Entity type:Individual
Prefix:
First Name:SY
Middle Name:LOUIS
Last Name:TERAVEST
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 1:2460 118TH AVE
Mailing Address - Street 2:
Mailing Address - City:ALLEGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49010-9552
Mailing Address - Country:US
Mailing Address - Phone:269-680-1082
Mailing Address - Fax:
Practice Address - Street 1:130 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MI
Practice Address - Zip Code:49328-5128
Practice Address - Country:US
Practice Address - Phone:269-682-5060
Practice Address - Fax:269-682-5061
Is Sole Proprietor?:No
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301401462111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor