Provider Demographics
NPI:1710091152
Name:TABAROVSKAYA, OLGA (DC)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:TABAROVSKAYA
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 1:8205 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 12-B
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-5977
Mailing Address - Country:US
Mailing Address - Phone:323-819-5099
Mailing Address - Fax:323-656-5115
Practice Address - Street 1:8205 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 12-B
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-5977
Practice Address - Country:US
Practice Address - Phone:323-819-5099
Practice Address - Fax:323-656-5115
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC30275111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor