MEDICARE: AATAVIC CHIROPRACTIC CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH6436	FL

General Provider Information

NPI Number	:	1063580629
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AATAVIC CHIROPRACTIC CENTER INC

Provider Business Mailing Address
First Line	:	PO BOX 21727
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33622-1727
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13910 N DALE MABRY HWY
Second Line	:	BLDG 4, STE 1
City	:	TAMPA
State	:	FL
Zip	:	33618-2440
Country	:	US
Telephone Number	:	813-963-2200
Fax Number	:

Authorized Official
Title or Position	:	OWNER - PROVIDER
Name	:	HARSHA KABARIA
Credential	:	DC
Telephone Number	:	813-963-2200

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	08/22/2020

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