Provider Demographics
NPI:1720169105
Name:TETA, STEPHEN RICHARD III (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:RICHARD
Last Name:TETA
Suffix:III
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 1:77 E MERRIMACK ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-1251
Mailing Address - Country:US
Mailing Address - Phone:978-323-4441
Mailing Address - Fax:978-323-4401
Practice Address - Street 1:77 E MERRIMACK ST
Practice Address - Street 2:SUITE 6
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1251
Practice Address - Country:US
Practice Address - Phone:978-323-4441
Practice Address - Fax:978-323-4401
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2831111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MATEY45710Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER
MAMIY49178Medicare ID - Type UnspecifiedGROUP NUMBER