Healthcare Provider Details

I. General information

NPI: 1609864024
Provider Name (Legal Business Name): ILYNE KOBRIN URBANOVICH D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 04/18/2021
Certification Date: 04/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 S TAMPANIA AVE
TAMPA FL
33609-4146
US

IV. Provider business mailing address

PO BOX 20454
TAMPA FL
33622-0454
US

V. Phone/Fax

Practice location:
  • Phone: 813-390-3009
  • Fax:
Mailing address:
  • Phone: 813-390-3009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6308
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: