Provider Demographics
NPI:1164590410
Name:PAVLOVIC, DEBRA JEAN (DC)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:JEAN
Last Name:PAVLOVIC
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 1:4122 EL CAMINO REAL E
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-1021
Mailing Address - Country:US
Mailing Address - Phone:863-393-4169
Mailing Address - Fax:863-937-6267
Practice Address - Street 1:4122 EL CAMINO REAL E
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-1021
Practice Address - Country:US
Practice Address - Phone:863-393-4169
Practice Address - Fax:863-937-6267
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008047111N00000X
MI2301009231111N00000X
SC3224111N00000X
FLCH9372111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor