Provider Demographics
NPI:1477713600
Name:BLOUKOS, THEODORE JAMES (DC)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:JAMES
Last Name:BLOUKOS
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 1:141 NW 20TH ST
Mailing Address - Street 2:SUITE B-15
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-7966
Mailing Address - Country:US
Mailing Address - Phone:561-368-2461
Mailing Address - Fax:
Practice Address - Street 1:141 NW 20TH ST
Practice Address - Street 2:SUITE B-15
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-7966
Practice Address - Country:US
Practice Address - Phone:561-368-2461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0005220111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70996Medicare PIN