=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699810143
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAUL SALVATORE TETRO D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/21/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 831 UNIVERSITY BLVD E STE 35
-----------------------------------------------------
City | SILVER SPRING
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20903-2915
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-445-6900
-----------------------------------------------------
Fax | 301-445-6592
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 831 UNIVERSITY BLVD E STE 35
-----------------------------------------------------
City | SILVER SPRING
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20903-2915
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-445-6900
-----------------------------------------------------
Fax | 301-445-6592
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 1915
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------