Provider Demographics
NPI:1023280476
Name:KOUSOULI, THEODORE DEMOSTHENIS (DC, CHT)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:DEMOSTHENIS
Last Name:KOUSOULI
Suffix:
Gender:M
Credentials:DC, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 E MAIN ST STE 204
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-2569
Mailing Address - Country:US
Mailing Address - Phone:615-435-3643
Mailing Address - Fax:
Practice Address - Street 1:198 E MAIN ST STE 204
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-2569
Practice Address - Country:US
Practice Address - Phone:615-435-3643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-26
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC30120111N00000X
TNDC3349111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor