Provider Demographics
NPI:1861591810
Name:CAROLAN, TERRANCE PATRICK (DC)
Entity type:Individual
Prefix:DR
First Name:TERRANCE
Middle Name:PATRICK
Last Name:CAROLAN
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 133
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MO
Mailing Address - Zip Code:63025-0133
Mailing Address - Country:US
Mailing Address - Phone:636-938-4414
Mailing Address - Fax:
Practice Address - Street 1:300 W 4TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:EUREKA
Practice Address - State:MO
Practice Address - Zip Code:63025-1839
Practice Address - Country:US
Practice Address - Phone:636-938-4414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000153523111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO5632071OtherFIRST HEALTH
MO433186OtherHEALTHLINK
MO44-02215OtherUNITED HEALTH CARE
MO44-02215OtherMEDICARE COMPLETE
MO132036OtherBLUE CROSS BLUE SHIELD
MOU79878Medicare UPIN