Provider Demographics
NPI:1417003237
Name:PALIVIDAS, CONSTANTINE S (DC)
Entity Type:Individual
Prefix:
First Name:CONSTANTINE
Middle Name:S
Last Name:PALIVIDAS
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 1:909 DAIRY ASHFORD ST STE 103
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-5306
Mailing Address - Country:US
Mailing Address - Phone:281-589-2424
Mailing Address - Fax:281-589-2424
Practice Address - Street 1:909 DAIRY ASHFORD ST STE 103
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-5306
Practice Address - Country:US
Practice Address - Phone:281-589-2424
Practice Address - Fax:281-589-2424
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5334111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor