Provider Demographics
NPI:1194083303
Name:GIL DE RUBIO, AUDREY ISABEL (DC)
Entity type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:ISABEL
Last Name:GIL DE RUBIO
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 1:6634 MERRYVALE LN
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32128-4037
Mailing Address - Country:US
Mailing Address - Phone:386-882-4705
Mailing Address - Fax:
Practice Address - Street 1:136 N ORCHARD ST STE 3
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-9535
Practice Address - Country:US
Practice Address - Phone:386-882-4705
Practice Address - Fax:386-868-1560
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-25
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10626111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor