Healthcare Provider Details

I. General information

NPI: 1740490242
Provider Name (Legal Business Name): SPIROS T THEODORE DC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12105 DARNESTOWN RD SUITE L-8
GAITHERSBURG MD
20854
US

IV. Provider business mailing address

12105 DARNESTOWN ROAD SUITE L-8
GAITHERSBURG MD
20878
US

V. Phone/Fax

Practice location:
  • Phone: 301-869-0006
  • Fax: 301-869-0201
Mailing address:
  • Phone: 301-869-0006
  • Fax: 301-869-0201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number02045
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberS02045
License Number StateMD

VIII. Authorized Official

Name: SPIRO T THEODORE
Title or Position: PRESIDENT
Credential: DC
Phone: 301-869-0006