Provider Demographics
NPI:1457363533
Name:KLIMEDIOTIS, JOHN (DC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:KLIMEDIOTIS
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 1:3 S PROSPECT AVE
Mailing Address - Street 2:SUITE 8
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-4177
Mailing Address - Country:US
Mailing Address - Phone:847-296-0505
Mailing Address - Fax:848-827-1037
Practice Address - Street 1:3 S PROSPECT AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-4177
Practice Address - Country:US
Practice Address - Phone:847-296-0505
Practice Address - Fax:848-827-1037
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-008803111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL214941Medicare PIN
ILU98488Medicare UPIN
ILK36531Medicare PIN