Provider Demographics
NPI:1043452220
Name:DR. ILYNE KOBRIN
Entity type:Organization
Organization Name:DR. ILYNE KOBRIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ILYNE
Authorized Official - Middle Name:KOBRIN
Authorized Official - Last Name:URBANOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:239-263-3330
Mailing Address - Street 1:11075 E ACACIA DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-2418
Mailing Address - Country:US
Mailing Address - Phone:239-263-3330
Mailing Address - Fax:
Practice Address - Street 1:11075 E ACACIA DR
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-2418
Practice Address - Country:US
Practice Address - Phone:239-263-3330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-02
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6308111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22665ZOtherMEDICARE PTAN