Provider Demographics
NPI:1063580629
Name:AATAVIC CHIROPRACTIC CENTER INC
Entity type:Organization
Organization Name:AATAVIC CHIROPRACTIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER - PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:HARSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KABARIA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:813-963-2200
Mailing Address - Street 1:PO BOX 21727
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33622-1727
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13910 N DALE MABRY HWY
Practice Address - Street 2:BLDG 4, STE 1
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2440
Practice Address - Country:US
Practice Address - Phone:813-963-2200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6436111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U57500Medicare UPIN
FL55342Medicare ID - Type Unspecified