Provider Demographics
NPI:1033488390
Name:EVENSTEIN, SAMUEL (DC)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:
Last Name:EVENSTEIN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6802 W HILLSBOROUGH AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-5004
Mailing Address - Country:US
Mailing Address - Phone:813-890-8811
Mailing Address - Fax:813-890-0088
Practice Address - Street 1:6802 W HILLSBOROUGH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-5004
Practice Address - Country:US
Practice Address - Phone:813-890-8811
Practice Address - Fax:813-890-0088
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-15
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA-53141225700000X
FLCH 11647111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist