MEDICARE: ANTHOULA VANDOROS

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	CH12435	FL

General Provider Information

NPI Number	:	1770148868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHOULA VANDOROS

Provider Business Mailing Address
First Line	:	144 DOUGLAS RD W APT F
Second Line	:
City	:	OLDSMAR
State	:	FL
Zip	:	34677-2817
Country	:	US
Telephone Number	:	508-250-9149
Fax Number	:

Provider Business Practice Location Address
First Line	:	2661 E LAKE RD
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34685-2034
Country	:	US
Telephone Number	:	727-216-6775
Fax Number	:

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

Provider Enumeration Date	:	05/05/2019
Last Update Date	:	05/05/2019

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Directions to “ ANTHOULA VANDOROS ” Practice Location

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