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General NPI Number Information
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NPI Number | 1548560527
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Entity Type | Organization
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Legal Business Name | COMPLETE HEALTH MEDICAL P.C.
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Dates
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Enumeration Date | 10/25/2010
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Last Update Date | 03/14/2021
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Provider Practice Location Address
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Address Line | 3400 NESCONSET HWY STE 102
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City | EAST SETAUKET
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State | NY
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Zip | 11733-3327
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Country | US
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Telephone | 631-751-5700
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Fax | 631-444-0193
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Provider Business Mailing Address
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Address Line | 3400 NESCONSET HWY SUITE 102
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City | EAST SETAUKET
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State | NY
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Zip | 11733-3339
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Country | US
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Telephone | 631-751-5700
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Fax | 631-444-0193
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Authorized Official
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Title or Position | OWNER/MEDICAL DIRECTOR
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Name | DR. DIMOS G KANAKOUDAS
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Credential | MD,DC,MS.
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Telephone | 631-751-5700
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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 | 010895
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | 257261
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License Number State | NY
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