Provider Demographics
NPI:1447451281
Name:ATHENOS MEDICAL DIAGNOSTICS LTD
Entity type:Organization
Organization Name:ATHENOS MEDICAL DIAGNOSTICS LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DREW
Authorized Official - Middle Name:S
Authorized Official - Last Name:KANDILAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:877-278-1437
Mailing Address - Street 1:1033 PETERSON AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-5184
Mailing Address - Country:US
Mailing Address - Phone:877-278-1437
Mailing Address - Fax:630-969-4528
Practice Address - Street 1:1033 PETERSON AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-5184
Practice Address - Country:US
Practice Address - Phone:877-278-1437
Practice Address - Fax:630-390-2222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038007934111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty