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General NPI Number Information
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NPI Number | 1700846151
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Entity Type | Individual
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Provider Name | MARC STUART TEREBELO D.C.
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Gender | Male
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Dates
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Enumeration Date | 03/27/2006
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Last Update Date | 01/16/2020
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Provider Practice Location Address
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Address Line | 30555 SOUTHFIELD RD STE 155
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City | SOUTHFIELD
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State | MI
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Zip | 48076-7750
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Country | US
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Telephone | 248-593-8282
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Fax | 248-593-8284
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Provider Business Mailing Address
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Address Line | PO BOX 37
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City | CHARLOTTE
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State | MI
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Zip | 48813-0037
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Country | US
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Telephone | 517-541-3395
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2301004602
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License Number State | MI
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