=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366864944
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | G&S CHIROPRACTIC AND REHAB
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/15/2014
-----------------------------------------------------
Last Update Date | 01/15/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 29 N PINELLAS AVE
-----------------------------------------------------
City | TARPON SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34689-3435
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-934-7246
-----------------------------------------------------
Fax | 727-934-7245
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 29 N PINELLAS AVE
-----------------------------------------------------
City | TARPON SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34689-3435
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-934-7246
-----------------------------------------------------
Fax | 727-934-7245
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR/OWNER
-----------------------------------------------------
Name | DR. KONSTANTINOS GALOUZIS
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 727-934-7246
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH8327
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------