Healthcare Provider Details

I. General information

NPI: 1255659769
Provider Name (Legal Business Name): THOMAS P. HABAN, D.C., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2010
Last Update Date: 05/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6595 NW 36TH ST SUITE 202
VIRGINIA GARDENS FL
33166-6979
US

IV. Provider business mailing address

6595 NW 36TH ST SUITE 202
VIRGINIA GARDENS FL
33166-6979
US

V. Phone/Fax

Practice location:
  • Phone: 305-871-3700
  • Fax:
Mailing address:
  • Phone: 305-871-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberCH8590
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License NumberME79374
License Number StateFL

VIII. Authorized Official

Name: DR. THOMAS PATRICK HABAN
Title or Position: CHIROPRACTIC PHYSICIAN/OWNER PRES.
Credential: D.C.
Phone: 305-871-3700