Provider Demographics
NPI:1922737519
Name:GHEBRAI, ERMIYAS HABTEAB (DC)
Entity Type:Individual
Prefix:DR
First Name:ERMIYAS
Middle Name:HABTEAB
Last Name:GHEBRAI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6708 MIRROR LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-1065
Mailing Address - Country:US
Mailing Address - Phone:813-454-3377
Mailing Address - Fax:
Practice Address - Street 1:6708 MIRROR LAKE AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-1065
Practice Address - Country:US
Practice Address - Phone:813-454-3377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14096111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor