Demetrios Agis Kydonieus, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

38MC00566000 Issued in NJ

Practice address

435 Buckhorn Dr
Belvidere, NJ 07823-2710

Phone

(908) 763-1178

Fax

(908) 750-4267

NPI assigned

Dec 15, 2006

Last updated

Dec 17, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Specialty

Chiropractic

Education

Life Chiropractic College, 1988

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Life Enhancing Wellness Centers, LLC

  • Nutrition Chiropractor
  • Ruckersville, VA
  • NPI 1043759863
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1545004800000",
    "number": "1316009301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8881 SEMINOLE TRL",
            "city": "RUCKERSVILLE",
            "state": "VA",
            "postal_code": "229683448",
            "telephone_number": "434-481-2012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "435 BUCKHORN DR",
            "city": "BELVIDERE",
            "state": "NJ",
            "postal_code": "078232710",
            "telephone_number": "908-763-1178",
            "fax_number": "908-750-4267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KYDONIEUS",
        "first_name": "DEMETRIOS",
        "middle_name": "AGIS",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-15",
        "last_updated": "2018-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NJ",
            "license": "38MC00566000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL TAX ID",
            "identifier": "58-1893942",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lydia Jordan, LCSW, LCADC
• Scott J Jordan, DPT
• Jacqueline Mele Kaufman, RPH
• Nicholas Michael Kavcsak, O.D.
• Kelli Kennedy, CMA, NAVIGATOR
• Jennifer Lewis, OTR
• Tejashree Limaye
• Living and Learning Counseling Services
• Gerald A Mauriello Jr Jr., DPM, MA, LAC
• Maximum Solutions,Inc

• Chiropractor in Belvidere, NJ
• Providers in Belvidere, NJ by specialty
• Chiropractor in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.