Provider Demographics
NPI:1457358855
Name:THEODORE, SPIROS T (DC PC)
Entity type:Individual
Prefix:DR
First Name:SPIROS
Middle Name:T
Last Name:THEODORE
Suffix:
Gender:M
Credentials:DC PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12105 DARNESTOWN RD
Mailing Address - Street 2:SUITE L-8
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-2217
Mailing Address - Country:US
Mailing Address - Phone:301-869-0006
Mailing Address - Fax:301-869-0201
Practice Address - Street 1:12105 DARNESTOWN RD
Practice Address - Street 2:SUITE L-8
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-2217
Practice Address - Country:US
Practice Address - Phone:301-869-0006
Practice Address - Fax:301-869-0201
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS02045111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCS-860-0001OtherBC/BS OF DC
MD349882OtherMAMSI
MDKCS6POOtherBC/BS OF MD
DC491913Medicare ID - Type UnspecifiedMEDICARE