Provider Demographics
NPI:1770134132
Name:TELLO, JUSTIN M
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:M
Last Name:TELLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5420 LAND O' LAKES BLVD SUITE 105
Mailing Address - Street 2:
Mailing Address - City:LAND O' LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34639
Mailing Address - Country:US
Mailing Address - Phone:727-365-7674
Mailing Address - Fax:
Practice Address - Street 1:5420 LAND O' LAKES BLVD SUITE 105
Practice Address - Street 2:
Practice Address - City:LAND O' LAKES
Practice Address - State:FL
Practice Address - Zip Code:34639
Practice Address - Country:US
Practice Address - Phone:813-996-9800
Practice Address - Fax:813-874-0471
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-26
Last Update Date:2025-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12893111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor