Provider Demographics
NPI:1659321867
Name:TERESO, PAULO (DC)
Entity Type:Individual
Prefix:
First Name:PAULO
Middle Name:
Last Name:TERESO
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 1:101 MOTYKA ST
Mailing Address - Street 2:
Mailing Address - City:LUDLOW
Mailing Address - State:MA
Mailing Address - Zip Code:01056-2129
Mailing Address - Country:US
Mailing Address - Phone:413-736-5491
Mailing Address - Fax:
Practice Address - Street 1:868 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-2105
Practice Address - Country:US
Practice Address - Phone:413-736-5491
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2746111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY37014OtherBLUECROSS BLUESHIELD
MAU92579Medicare UPIN
MAY45572Medicare ID - Type UnspecifiedMEDICARE