Provider Demographics
NPI:1154771145
Name:TETZLAFF, DARCELLE (DC)
Entity type:Individual
Prefix:
First Name:DARCELLE
Middle Name:
Last Name:TETZLAFF
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:DARCY
Other - Middle Name:
Other - Last Name:TETZLAFF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:5939 SE BELMONT ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-1994
Mailing Address - Country:US
Mailing Address - Phone:503-231-8877
Mailing Address - Fax:
Practice Address - Street 1:5939 SE BELMONT ST UNIT A
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-1994
Practice Address - Country:US
Practice Address - Phone:503-231-8877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
OR5732111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health