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General NPI Number Information
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NPI Number | 1528346285
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Entity Type | Organization
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Legal Business Name | TSAMOUTALIDIS CHIROPRACTIC CORPORATIO
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Dates
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Enumeration Date | 07/29/2011
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Last Update Date | 07/29/2011
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Provider Practice Location Address
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Address Line | 21139 NEWPORT COAST DR
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City | NEWPORT COAST
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State | CA
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Zip | 92657-1122
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Country | US
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Telephone | 951-314-3088
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Fax | 951-840-2320
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Provider Business Mailing Address
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Address Line | 14 TRANTO DR
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City | NEWPORT COAST
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State | CA
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Zip | 92657-1508
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Country | US
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Telephone | 951-314-3088
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Fax | 951-840-2320
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Authorized Official
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Title or Position | OWNER
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Name | MR. KONSTANTINOS TSAMOUTALIDIS
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Credential | DC
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Telephone | 951-314-3088
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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 | DC28189
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License Number State | CA
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