Provider Demographics
NPI:1194866467
Name:KOULTUKIS, CHRIS (DC, LAC)
Entity Type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:
Last Name:KOULTUKIS
Suffix:
Gender:M
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 W 57TH ST
Mailing Address - Street 2:SUITE 308
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-3158
Mailing Address - Country:US
Mailing Address - Phone:212-580-2900
Mailing Address - Fax:212-265-0217
Practice Address - Street 1:315 W 57TH ST
Practice Address - Street 2:SUITE 308
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-3158
Practice Address - Country:US
Practice Address - Phone:212-580-2900
Practice Address - Fax:212-265-0217
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX004361-1111N00000X
NY001046171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY001046OtherACUPUNCTURE LICIENCE
NYX004361-1OtherCHIROPRACTIC LICENCE
NYX004361-1OtherCHIROPRACTIC LICENCE