Provider Demographics
NPI:1497742993
Name:ATHANS, DEMETRIOS J (DC)
Entity Type:Individual
Prefix:DR
First Name:DEMETRIOS
Middle Name:J
Last Name:ATHANS
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 1:8909 REGENTS PARK DR
Mailing Address - Street 2:SUITE 410
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3433
Mailing Address - Country:US
Mailing Address - Phone:813-994-2266
Mailing Address - Fax:813-774-7827
Practice Address - Street 1:8909 REGENTS PARK DR
Practice Address - Street 2:SUITE 410
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-3433
Practice Address - Country:US
Practice Address - Phone:813-994-2266
Practice Address - Fax:813-774-7827
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7004111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381952301Medicaid
FLU56640Medicare UPIN
FL55476Medicare ID - Type Unspecified