Provider Demographics
NPI:1801060389
Name:MALTEZOS, THEODORE
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:
Last Name:MALTEZOS
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:TEDDY
Other - Middle Name:
Other - Last Name:MALTEZOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:4851 LEGACY DR STE 307
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-0853
Mailing Address - Country:US
Mailing Address - Phone:972-377-3909
Mailing Address - Fax:972-377-4061
Practice Address - Street 1:4851 LEGACY DR STE 307
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-0853
Practice Address - Country:US
Practice Address - Phone:972-377-3909
Practice Address - Fax:972-377-4061
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8841111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor