Provider Demographics
NPI:1992830277
Name:TELLO, RAUL ALEJANDRO (DC)
Entity Type:Individual
Prefix:
First Name:RAUL
Middle Name:ALEJANDRO
Last Name:TELLO
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 1:4413 36TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-5626
Mailing Address - Country:US
Mailing Address - Phone:206-529-9443
Mailing Address - Fax:206-529-9444
Practice Address - Street 1:4413 36TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-5626
Practice Address - Country:US
Practice Address - Phone:206-529-9443
Practice Address - Fax:206-529-9444
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA999999999111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor