Provider Demographics
NPI:1861721375
Name:DEMETROS, JOHN T (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:T
Last Name:DEMETROS
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 1:238 LAKE STREET PLZ
Mailing Address - Street 2:
Mailing Address - City:PENN YAN
Mailing Address - State:NY
Mailing Address - Zip Code:14527-1811
Mailing Address - Country:US
Mailing Address - Phone:315-536-2048
Mailing Address - Fax:
Practice Address - Street 1:238 LAKE STREET PLZ
Practice Address - Street 2:
Practice Address - City:PENN YAN
Practice Address - State:NY
Practice Address - Zip Code:14527-1811
Practice Address - Country:US
Practice Address - Phone:315-536-2048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-11
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010203111N00000X
NYX011794111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor