Provider Demographics
NPI:1114524303
Name:TELA, TAKURA ABUS (DC)
Entity Type:Individual
Prefix:
First Name:TAKURA
Middle Name:ABUS
Last Name:TELA
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 1:600 JEFFERSON PLZ STE 350
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-1157
Mailing Address - Country:US
Mailing Address - Phone:301-279-9009
Mailing Address - Fax:301-279-9008
Practice Address - Street 1:600 JEFFERSON PLZ STE 350
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-1157
Practice Address - Country:US
Practice Address - Phone:301-279-9009
Practice Address - Fax:301-279-9008
Is Sole Proprietor?:No
Enumeration Date:2020-10-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS04062111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician