Provider Demographics
NPI:1316971369
Name:KANDILAKIS, DREW S (DC)
Entity type:Individual
Prefix:DR
First Name:DREW
Middle Name:S
Last Name:KANDILAKIS
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:PO BOX 85
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-0085
Mailing Address - Country:US
Mailing Address - Phone:877-278-1437
Mailing Address - Fax:630-390-2222
Practice Address - Street 1:9820 MILWAUKEE AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-1805
Practice Address - Country:US
Practice Address - Phone:312-804-8910
Practice Address - Fax:630-390-2222
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038007934111N00000X
IL038-007934293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No293D00000XLaboratoriesPhysiological Laboratory