Provider Demographics
NPI:1194117218
Name:MABRY CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:MABRY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:MABRY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-758-0177
Mailing Address - Street 1:11211 PROSPERITY FARMS RD STE D223
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-3491
Mailing Address - Country:US
Mailing Address - Phone:561-758-0177
Mailing Address - Fax:561-627-9231
Practice Address - Street 1:11211 PROSPERITY FARMS RD STE D223
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-3491
Practice Address - Country:US
Practice Address - Phone:561-758-0177
Practice Address - Fax:561-627-9231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-26
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9797111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCO384AOtherMEDICARE PTAN