Provider Demographics
NPI:1235165564
Name:KRAKOS, GARRY THOMAS (DC)
Entity Type:Individual
Prefix:DR
First Name:GARRY
Middle Name:THOMAS
Last Name:KRAKOS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6120 BRANDON AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150-2522
Mailing Address - Country:US
Mailing Address - Phone:703-644-2222
Mailing Address - Fax:703-644-2488
Practice Address - Street 1:6120 BRANDON AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-2522
Practice Address - Country:US
Practice Address - Phone:703-644-2222
Practice Address - Fax:703-644-2488
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104555563111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA180780OtherANTHEM
VA180780OtherANTHEM