Healthcare Provider Details

I. General information

NPI: 1114910700
Provider Name (Legal Business Name): MICHAEL TEREO D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2005
Last Update Date: 03/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6287 JARVIS AVE
NEWARK CA
94560-1212
US

IV. Provider business mailing address

6287 JARVIS AVE
NEWARK CA
94560-1212
US

V. Phone/Fax

Practice location:
  • Phone: 510-795-2700
  • Fax: 510-795-2845
Mailing address:
  • Phone: 510-795-2700
  • Fax: 510-795-2845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDC18666
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: