Provider Demographics
NPI:1730905688
Name:THEOFYLAKTOS, ALEXANDER (DC)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:
Last Name:THEOFYLAKTOS
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4635 RICHMOND RD STE 101
Mailing Address - Street 2:
Mailing Address - City:WARRENSVILLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44128-5938
Mailing Address - Country:US
Mailing Address - Phone:216-459-7998
Mailing Address - Fax:
Practice Address - Street 1:4635 RICHMOND RD STE 101
Practice Address - Street 2:
Practice Address - City:WARRENSVILLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44128-5938
Practice Address - Country:US
Practice Address - Phone:216-459-7998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-25
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC-05407111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor