Provider Demographics
NPI:1427830272
Name:PREDESTIN, TATIANAH (DC)
Entity type:Individual
Prefix:DR
First Name:TATIANAH
Middle Name:
Last Name:PREDESTIN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 RENAISSANCE COMMONS BLVD APT 538
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-8289
Mailing Address - Country:US
Mailing Address - Phone:561-255-6993
Mailing Address - Fax:
Practice Address - Street 1:1605 RENAISSANCE COMMONS BLVD APT 538
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-8289
Practice Address - Country:US
Practice Address - Phone:561-255-6993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH14705111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor