Provider Demographics
NPI:1760030332
Name:HABANOVA, TATIANA (DC, DACNB)
Entity type:Individual
Prefix:DR
First Name:TATIANA
Middle Name:
Last Name:HABANOVA
Suffix:
Gender:F
Credentials:DC, DACNB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2642 FAIRWAY COVE CT
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-7789
Mailing Address - Country:US
Mailing Address - Phone:561-204-5393
Mailing Address - Fax:
Practice Address - Street 1:12300 S SHORE BLVD STE 218
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6509
Practice Address - Country:US
Practice Address - Phone:561-444-7518
Practice Address - Fax:561-666-1311
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-27
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8157111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty