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General NPI Number Information
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NPI Number | 1447451281
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Entity Type | Organization
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Legal Business Name | ATHENOS MEDICAL DIAGNOSTICS LTD
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Dates
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Enumeration Date | 05/30/2007
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Last Update Date | 09/17/2012
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Provider Practice Location Address
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Address Line | 1033 PETERSON AVE SUITE 208
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City | PARK RIDGE
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State | IL
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Zip | 60068-5184
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Country | US
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Telephone | 877-278-1437
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Fax | 630-390-2222
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Provider Business Mailing Address
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Address Line | 1033 PETERSON AVE SUITE 208
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City | PARK RIDGE
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State | IL
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Zip | 60068-5184
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Country | US
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Telephone | 877-278-1437
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Fax | 630-969-4528
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Authorized Official
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Title or Position | CEO
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Name | DR. DREW S KANDILAKIS
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Credential | D.C.
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Telephone | 877-278-1437
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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 | 038007934
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License Number State | IL
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