Provider Demographics
NPI:1467967117
Name:MAYBERRY, SAVANNAH JANE (DC)
Entity Type:Individual
Prefix:DR
First Name:SAVANNAH
Middle Name:JANE
Last Name:MAYBERRY
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 1:10601 GANDY BLVD N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-1470
Mailing Address - Country:US
Mailing Address - Phone:608-408-9539
Mailing Address - Fax:
Practice Address - Street 1:3140 34TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-2404
Practice Address - Country:US
Practice Address - Phone:608-408-9539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-04
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12293111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor