Provider Demographics
NPI:1235335464
Name:TAKTIKOS, ELENA ATHENA (DC)
Entity Type:Individual
Prefix:DR
First Name:ELENA
Middle Name:ATHENA
Last Name:TAKTIKOS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 TYRONE BLVD N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-4025
Mailing Address - Country:US
Mailing Address - Phone:727-347-3400
Mailing Address - Fax:727-347-0502
Practice Address - Street 1:2205 TYRONE BLVD N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-4025
Practice Address - Country:US
Practice Address - Phone:727-347-3400
Practice Address - Fax:727-347-0502
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9394111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor