1609087188 NPI number — DR. JOHN KLEIN TETA ND, LAC, CSCS

Table of content: DR. JOHN KLEIN TETA ND, LAC, CSCS (NPI 1609087188)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609087188 NPI number — DR. JOHN KLEIN TETA ND, LAC, CSCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TETA
Provider First Name:
JOHN
Provider Middle Name:
KLEIN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
ND, LAC, CSCS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TETA
Provider Other First Name:
KEONI
Provider Other Middle Name:
KLEIN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
ND, LAC, CSCS
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1609087188
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
114 REYNOLDA VLG STE L
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINSTON SALEM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27106-5131
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-724-4452
Provider Business Mailing Address Fax Number:
877-886-3348

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
114 REYNOLDA VLG STE L
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINSTON SALEM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27106-5131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-724-4452
Provider Business Practice Location Address Fax Number:
877-886-3348
Provider Enumeration Date:
05/25/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  311 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 175F00000X , with the licence number: 1225 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)