Provider Demographics
NPI:1477076859
Name:TRETERA, JUSTIN C (DC)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:C
Last Name:TRETERA
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 1:5750 RIVERS AVE UNIT A
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-6029
Mailing Address - Country:US
Mailing Address - Phone:843-723-6475
Mailing Address - Fax:843-722-4845
Practice Address - Street 1:5750 RIVERS AVE UNIT A
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-6029
Practice Address - Country:US
Practice Address - Phone:843-723-6475
Practice Address - Fax:843-722-4845
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-18
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4252111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor