MEDICARE: DR. ANDRIA MIA THEOHARIDIS D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2000167940	MO

General Provider Information

NPI Number	:	1699851527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDRIA MIA THEOHARIDIS D.C.

Provider Business Mailing Address
First Line	:	601 S STATE ROUTE 291 STE 3
Second Line	:
City	:	LIBERTY
State	:	MO
Zip	:	64068-1975
Country	:	US
Telephone Number	:	816-429-6598
Fax Number	:	816-429-8471

Provider Business Practice Location Address
First Line	:	601 S STATE ROUTE 291 STE 3
Second Line	:
City	:	LIBERTY
State	:	MO
Zip	:	64068-1975
Country	:	US
Telephone Number	:	816-429-6598
Fax Number	:	816-429-8471

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2006
Last Update Date	:	02/27/2026

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