Healthcare Provider Details

I. General information

NPI: 1861382616
Provider Name (Legal Business Name): SPIROS KONSTANTINOS THEODOSIOU DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2025
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17075 DEVONSHIRE ST STE 204
NORTHRIDGE CA
91325-5408
US

IV. Provider business mailing address

PO BOX 4547
WEST HILLS CA
91308-4547
US

V. Phone/Fax

Practice location:
  • Phone: 818-900-2068
  • Fax:
Mailing address:
  • Phone: 818-900-2068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number35275
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: