Provider Demographics
NPI:1669090312
Name:TSAKIRIS, CHRISTIAN DEREK
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:DEREK
Last Name:TSAKIRIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 CRAFTS AVE
Mailing Address - Street 2:
Mailing Address - City:WEST LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03784-1124
Mailing Address - Country:US
Mailing Address - Phone:603-359-2719
Mailing Address - Fax:
Practice Address - Street 1:59 CRAFTS AVE
Practice Address - Street 2:
Practice Address - City:WEST LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03784-1124
Practice Address - Country:US
Practice Address - Phone:603-359-2719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-09
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer