MEDICARE: DR. PAUL SALVATORE TETRO D.C.

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	1915	MD

General Provider Information

NPI Number	:	1699810143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL SALVATORE TETRO D.C.

Provider Business Mailing Address
First Line	:	831 UNIVERSITY BLVD E STE 35
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20903-2915
Country	:	US
Telephone Number	:	301-445-6900
Fax Number	:	301-445-6592

Provider Business Practice Location Address
First Line	:	831 UNIVERSITY BLVD E STE 35
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20903-2915
Country	:	US
Telephone Number	:	301-445-6900
Fax Number	:	301-445-6592

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	07/08/2007

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