Provider Demographics
NPI:1205903911
Name:ALVARADO, MARY JEANETTE (DC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:JEANETTE
Last Name:ALVARADO
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 1:322 S FALKENBURG RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-8026
Mailing Address - Country:US
Mailing Address - Phone:813-626-2311
Mailing Address - Fax:813-343-4233
Practice Address - Street 1:322 S FALKENBURG RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-8026
Practice Address - Country:US
Practice Address - Phone:813-626-2311
Practice Address - Fax:813-343-4233
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8297111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL89286OtherBCBS
FLU0010AMedicare ID - Type Unspecified
FL89286OtherBCBS