Provider Demographics
NPI:1881625515
Name:TEKERLEK, ARA M (DC)
Entity type:Individual
Prefix:
First Name:ARA
Middle Name:M
Last Name:TEKERLEK
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 1:8829 DAVIS RD STE 1
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95209-1871
Mailing Address - Country:US
Mailing Address - Phone:209-474-3764
Mailing Address - Fax:209-474-0506
Practice Address - Street 1:8829 DAVIS RD STE 1
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95209-1871
Practice Address - Country:US
Practice Address - Phone:209-474-3764
Practice Address - Fax:209-474-0506
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18665111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC01866650Medicare PIN