Provider Demographics
NPI:1609864024
Name:URBANOVICH, ILYNE KOBRIN (DC)
Entity Type:Individual
Prefix:DR
First Name:ILYNE
Middle Name:KOBRIN
Last Name:URBANOVICH
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:PO BOX 20454
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33622-0454
Mailing Address - Country:US
Mailing Address - Phone:813-390-3009
Mailing Address - Fax:
Practice Address - Street 1:506 S TAMPANIA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4146
Practice Address - Country:US
Practice Address - Phone:813-390-3009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2021-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6308111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22665OtherBCBSFL
FL22665OtherBCBSFL
FLU20533Medicare UPIN