MEDICARE: INNA MAYRKOVICH DC

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	X009330	NY

General Provider Information

NPI Number	:	1689926396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INNA MAYRKOVICH DC

Provider Business Mailing Address
First Line	:	632 UTICA AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-2210
Country	:	US
Telephone Number	:	347-955-4979
Fax Number	:	347-955-4978

Provider Business Practice Location Address
First Line	:	632 UTICA AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-2210
Country	:	US
Telephone Number	:	347-955-4979
Fax Number	:	347-955-4978

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2012
Last Update Date	:	10/04/2012

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Directions to “ INNA MAYRKOVICH DC” Practice Location

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