Provider Demographics
NPI:1699810143
Name:TETRO, PAUL SALVATORE (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:SALVATORE
Last Name:TETRO
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 1:831 UNIVERSITY BLVD E STE 35
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20903-2915
Mailing Address - Country:US
Mailing Address - Phone:301-445-6900
Mailing Address - Fax:301-445-6592
Practice Address - Street 1:831 UNIVERSITY BLVD E STE 35
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20903-2915
Practice Address - Country:US
Practice Address - Phone:301-445-6900
Practice Address - Fax:301-445-6592
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1915111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor