Provider Demographics
NPI:1114138336
Name:TELLEZ, MATTHEW R (DC, ND)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:R
Last Name:TELLEZ
Suffix:
Gender:M
Credentials:DC, ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1836 VALENCIA ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-4747
Mailing Address - Country:US
Mailing Address - Phone:360-733-9253
Mailing Address - Fax:
Practice Address - Street 1:1200 LAKEWAY DR STE 3
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98229-2034
Practice Address - Country:US
Practice Address - Phone:360-676-1961
Practice Address - Fax:360-676-1961
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00033709111N00000X
WANT00001183175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered175F00000XOther Service ProvidersNaturopath