=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831913185
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KALONTUROS CHIROPRACTIC, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/13/2024
-----------------------------------------------------
Last Update Date | 01/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15784 DOUGLAS ST
-----------------------------------------------------
City | MIDDLETOWN
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95461
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-740-8391
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 691
-----------------------------------------------------
City | MIDDLETOWN
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95461-0691
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-740-8391
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | GEORGE KALONTUROS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 703-899-0346
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------