Provider Demographics
NPI:1689226748
Name:KATAKIS, ANTONIOS EMMANUEL JR (DC)
Entity Type:Individual
Prefix:DR
First Name:ANTONIOS
Middle Name:EMMANUEL
Last Name:KATAKIS
Suffix:JR
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 1:17363 EDISON AVE
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63005-1250
Mailing Address - Country:US
Mailing Address - Phone:636-346-1274
Mailing Address - Fax:
Practice Address - Street 1:17363 EDISON AVE
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63005-1250
Practice Address - Country:US
Practice Address - Phone:636-346-1274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-09
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019015446111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor