Provider Demographics
NPI:1356443345
Name:PERISTERIDIS, EFTHIMIOS T (DC)
Entity type:Individual
Prefix:
First Name:EFTHIMIOS
Middle Name:T
Last Name:PERISTERIDIS
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 1:4205 AMELIA WAY
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-9043
Mailing Address - Country:US
Mailing Address - Phone:269-760-3994
Mailing Address - Fax:
Practice Address - Street 1:21740 S TAMIAMI TRL STE 103
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-2819
Practice Address - Country:US
Practice Address - Phone:239-676-9116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH15550111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU72633Medicare UPIN
MIOM71600Medicare ID - Type Unspecified