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General NPI Number Information
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NPI Number | 1770134132
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Entity Type | Individual
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Provider Name | MR. JUSTIN M TELLO
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Gender | Male
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Dates
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Enumeration Date | 09/26/2019
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 5420 LAND O' LAKES BLVD SUITE 105
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City | LAND O' LAKES
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State | FL
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Zip | 34639
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Country | US
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Telephone | 813-996-9800
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Fax | 813-874-0471
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Provider Business Mailing Address
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Address Line | 5420 LAND O' LAKES BLVD SUITE 105
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City | LAND O' LAKES
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State | FL
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Zip | 34639
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Country | US
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Telephone | 727-365-7674
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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 | 12893
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License Number State | FL
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