Provider Demographics
NPI:1528175957
Name:LETELLIER, DAVID R (CHIROPRACTOR)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:LETELLIER
Suffix:
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 VARNEY ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102-4108
Mailing Address - Country:US
Mailing Address - Phone:603-623-6621
Mailing Address - Fax:603-624-4540
Practice Address - Street 1:370 VARNEY ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-4108
Practice Address - Country:US
Practice Address - Phone:603-623-6621
Practice Address - Fax:603-624-4540
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH338-A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0508628Y0NH01OtherBCBS
NHNA1585OtherHARVARD PILGRIM
NH02918 NEW HAMPSHIREOtherAETNA
NH9510999OtherCIGNA