Provider Demographics
NPI:1023343399
Name:XENOS, THEODORE JUNIOR (DC)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:JUNIOR
Last Name:XENOS
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 1:1078 DOBBS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10607-2209
Mailing Address - Country:US
Mailing Address - Phone:914-310-9078
Mailing Address - Fax:914-909-4520
Practice Address - Street 1:3262 WESTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-4510
Practice Address - Country:US
Practice Address - Phone:718-904-0908
Practice Address - Fax:718-904-0117
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-05
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011863-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor