Individual provider Active NPI

Stephen Patrick Tetzlaff, D.C.

  • Chiropractor
  • Ceres, CA
National Provider Identifier
1710069216
Registry record updated Oct 16, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
189770 Issued in CA
Practice address
2531 E Whitmore Ave Ste L1
Ceres, CA 95307-2647
Phone
(209) 538-0647
Fax
(209) 538-8737
NPI assigned
Oct 20, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 16, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 189770 CA Primary

Addresses

Primary practice location

2531 E Whitmore Ave Ste L1
Ceres, CA 95307-2647

Mailing address

2531 E Whitmore Ave Ste L1
Ceres, CA 95307-2647
Phone (209) 538-0647

Other identifiers 1

IdentifierTypeStateIssuer
189770OtherCACHIROPRACTIC LICENSE #

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
189770CAMDChiropractor
18977CAMDAcupuncturist

Practice roles

OrganizationSpecialtyStatusNew patients
Tetzlaff Chiropractic, Inc. Chiropractor PastSince May 10, 2007 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1350345600000",
    "number": "1710069216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2531 E WHITMORE AVE STE L1",
            "city": "CERES",
            "state": "CA",
            "postal_code": "953072647",
            "telephone_number": "209-538-0647",
            "fax_number": "209-538-8737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2531 E WHITMORE AVE STE L1",
            "city": "CERES",
            "state": "CA",
            "postal_code": "953072647",
            "telephone_number": "209-538-0647",
            "fax_number": "209-538-8737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TETZLAFF",
        "first_name": "STEPHEN",
        "middle_name": "PATRICK",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-20",
        "last_updated": "2012-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "189770",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHIROPRACTIC LICENSE #",
            "identifier": "189770",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ceres, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.