Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | CH00033709 | WA |
N | 175F00000X | Naturopath | NT00001183 | WA |
NPI | 1114138336 |
---|---|
Provider Name | Dr. Matthew R Tellez |
First Address | Bellingham, WA 98229-4747 |
Second Address | Bellingham, WA 98229-2034 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2007 |
Last Update Date | 08/07/2007 |