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General NPI Number Information
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NPI Number | 1316009301
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Entity Type | Individual
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Provider Name | DEMETRIOS AGIS KYDONIEUS DC
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Gender | Male
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Dates
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Enumeration Date | 12/15/2006
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Last Update Date | 12/17/2018
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Provider Practice Location Address
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Address Line | 435 BUCKHORN DR
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City | BELVIDERE
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State | NJ
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Zip | 07823-2710
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Country | US
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Telephone | 908-763-1178
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Fax | 908-750-4267
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Provider Business Mailing Address
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Address Line | 8881 SEMINOLE TRL
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City | RUCKERSVILLE
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State | VA
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Zip | 22968-3448
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Country | US
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Telephone | 434-481-2012
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 38MC00566000
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License Number State | NJ
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