Provider Demographics
NPI:1689926396
Name:MAYRKOVICH, INNA (DC)
Entity Type:Individual
Prefix:
First Name:INNA
Middle Name:
Last Name:MAYRKOVICH
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 1:632 UTICA AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-2210
Mailing Address - Country:US
Mailing Address - Phone:347-955-4979
Mailing Address - Fax:347-955-4978
Practice Address - Street 1:632 UTICA AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2210
Practice Address - Country:US
Practice Address - Phone:347-955-4979
Practice Address - Fax:347-955-4978
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009330111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor