Provider Demographics
NPI:1750452868
Name:TELLIER, RICHARD PHILLIP (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:PHILLIP
Last Name:TELLIER
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 1:5420 LAND O LAKES BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34639-3401
Mailing Address - Country:US
Mailing Address - Phone:813-996-9800
Mailing Address - Fax:
Practice Address - Street 1:5420 LAND O LAKES BLVD STE 105
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34639-3401
Practice Address - Country:US
Practice Address - Phone:813-996-9800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-11
Last Update Date:2023-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12779111N00000X
NH754-1205111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor