Provider Demographics
NPI:1609087188
Name:TETA, JOHN KLEIN (ND, LAC, CSCS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:KLEIN
Last Name:TETA
Suffix:
Gender:M
Credentials:ND, LAC, CSCS
Other - Prefix:DR
Other - First Name:KEONI
Other - Middle Name:KLEIN
Other - Last Name:TETA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ND, LAC, CSCS
Mailing Address - Street 1:114 REYNOLDA VLG STE L
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-5131
Mailing Address - Country:US
Mailing Address - Phone:336-724-4452
Mailing Address - Fax:877-886-3348
Practice Address - Street 1:114 REYNOLDA VLG STE L
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-5131
Practice Address - Country:US
Practice Address - Phone:336-724-4452
Practice Address - Fax:877-886-3348
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC311171100000X
WA1225175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171100000XOther Service ProvidersAcupuncturist
Not Answered175F00000XOther Service ProvidersNaturopath