Provider Demographics
NPI:1831411073
Name:OTINIANO, JOSHUA LEE (DC)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:LEE
Last Name:OTINIANO
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 1:4602 N ARMENIA AVE
Mailing Address - Street 2:SUITE B-4/ B-5
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-2626
Mailing Address - Country:US
Mailing Address - Phone:813-874-6600
Mailing Address - Fax:813-874-6601
Practice Address - Street 1:4602 N ARMENIA AVE
Practice Address - Street 2:SUITE B-4/ B-5
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-2626
Practice Address - Country:US
Practice Address - Phone:813-874-6600
Practice Address - Fax:813-874-6601
Is Sole Proprietor?:No
Enumeration Date:2010-02-15
Last Update Date:2010-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7899111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition