Provider Demographics
NPI:1376555441
Name:ABOVYAN, MARI (DC)
Entity Type:Individual
Prefix:DR
First Name:MARI
Middle Name:
Last Name:ABOVYAN
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 1:50 NE 26TH AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-5239
Mailing Address - Country:US
Mailing Address - Phone:954-942-8924
Mailing Address - Fax:954-942-1982
Practice Address - Street 1:50 NE 26TH AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-5239
Practice Address - Country:US
Practice Address - Phone:954-942-8924
Practice Address - Fax:954-942-1982
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6350111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD26494Medicare UPIN
FL22709Medicare ID - Type Unspecified