MEDICARE: JUSTIN TELLO DC PA INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1679448245
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUSTIN TELLO DC PA INC

Provider Business Mailing Address
First Line	:	5420 LAND O LAKES BLVD STE 105
Second Line	:
City	:	LAND O LAKES
State	:	FL
Zip	:	34639-3401
Country	:	US
Telephone Number	:	813-996-9800
Fax Number	:	813-996-9800

Provider Business Practice Location Address
First Line	:	5420 LAND O LAKES BLVD STE 105
Second Line	:
City	:	LAND O LAKES
State	:	FL
Zip	:	34639-3401
Country	:	US
Telephone Number	:	813-996-9800
Fax Number	:	813-996-9800

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	KRISTINA NICOLE WEHLAU
Credential	:
Telephone Number	:	727-418-7288

Provider Enumeration Date	:	10/06/2025
Last Update Date	:	12/10/2025

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