Provider Demographics
NPI:1801055876
Name:TSAMOUTALIDIS, KONSTANTINOS (DC)
Entity type:Individual
Prefix:
First Name:KONSTANTINOS
Middle Name:
Last Name:TSAMOUTALIDIS
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 1:21139 NEWPORT COAST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92657
Mailing Address - Country:US
Mailing Address - Phone:951-640-2988
Mailing Address - Fax:951-755-0395
Practice Address - Street 1:21139 NEWPORT COAST DR
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92657
Practice Address - Country:US
Practice Address - Phone:951-640-2988
Practice Address - Fax:951-755-0395
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28189111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor