Provider Demographics
NPI:1366088437
Name:PANTERLIS, KIRIAKOS (DC)
Entity type:Individual
Prefix:DR
First Name:KIRIAKOS
Middle Name:
Last Name:PANTERLIS
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 1:434 KEARNY AVE # 129
Mailing Address - Street 2:
Mailing Address - City:KEARNY
Mailing Address - State:NJ
Mailing Address - Zip Code:07032-2604
Mailing Address - Country:US
Mailing Address - Phone:201-696-7968
Mailing Address - Fax:
Practice Address - Street 1:434 KEARNY AVE # 129
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-2604
Practice Address - Country:US
Practice Address - Phone:201-696-7968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-22
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00766400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor