Provider Demographics
NPI:1518603687
Name:TSAKALOS, KONSTANTINOS (DC)
Entity Type:Individual
Prefix:
First Name:KONSTANTINOS
Middle Name:
Last Name:TSAKALOS
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 1:3213 32ND ST # 1
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-2644
Mailing Address - Country:US
Mailing Address - Phone:954-562-1184
Mailing Address - Fax:
Practice Address - Street 1:594 BROADWAY RM 911
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-3289
Practice Address - Country:US
Practice Address - Phone:212-334-1933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-10
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013601111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty