Provider Demographics
NPI:1700846151
Name:TEREBELO, MARC STUART (DC)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:STUART
Last Name:TEREBELO
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:PO BOX 37
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48813-0037
Mailing Address - Country:US
Mailing Address - Phone:517-541-3395
Mailing Address - Fax:
Practice Address - Street 1:30555 SOUTHFIELD RD
Practice Address - Street 2:STE 155
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-7750
Practice Address - Country:US
Practice Address - Phone:248-593-8282
Practice Address - Fax:248-593-8284
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004602111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950F351800OtherBLUE CROSS BLUE SHIELD
MI950F351800OtherBLUE CROSS BLUE SHIELD
MIOF35180Medicare ID - Type Unspecified