Provider Demographics
NPI:1851430102
Name:TRAKHTENBERG, INNA S (DC)
Entity Type:Individual
Prefix:DR
First Name:INNA
Middle Name:S
Last Name:TRAKHTENBERG
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 1:225 179TH DR APT 201
Mailing Address - Street 2:
Mailing Address - City:SUNNY ISLES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-1934
Mailing Address - Country:US
Mailing Address - Phone:404-522-5552
Mailing Address - Fax:404-522-5151
Practice Address - Street 1:2500 E HALLANDALE BEACH BLVD STE 406
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4837
Practice Address - Country:US
Practice Address - Phone:954-990-0302
Practice Address - Fax:954-908-7101
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH-11660111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1851430102OtherCHIROPRACTOR/NUTRITIONIST