Provider Demographics
NPI:1780893834
Name:ETIENNE, SAVIENE PAUL (CHIROPRACTOR)
Entity type:Individual
Prefix:MR
First Name:SAVIENE
Middle Name:PAUL
Last Name:ETIENNE
Suffix:
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 NW 47TH AVE
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33313-5549
Mailing Address - Country:US
Mailing Address - Phone:954-730-7105
Mailing Address - Fax:954-730-7656
Practice Address - Street 1:4310 NW 12TH CT
Practice Address - Street 2:APT. #211
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33313-5700
Practice Address - Country:US
Practice Address - Phone:754-366-3322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6086111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor