Provider Demographics
NPI:1902801046
Name:WHEELER, TERRY KEITH (DC)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:KEITH
Last Name:WHEELER
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:PO BOX 1347
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:TX
Mailing Address - Zip Code:75951-0014
Mailing Address - Country:US
Mailing Address - Phone:409-384-5763
Mailing Address - Fax:409-384-1590
Practice Address - Street 1:145 CURTIS ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TX
Practice Address - Zip Code:75951-4505
Practice Address - Country:US
Practice Address - Phone:409-384-5763
Practice Address - Fax:409-384-1590
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC8752111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152536301Medicaid
TX8F3670OtherBLUE CROSS BLUE SHIELD
TXDC8752OtherCHIROPRACTIC
TX8F3670OtherBLUE CROSS BLUE SHIELD
TX152536301Medicaid