Provider Demographics
NPI:1386619989
Name:NOBLE, DAVID M (LAT, ATC)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:M
Last Name:NOBLE
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7607 BANCASTER DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-5717
Mailing Address - Country:US
Mailing Address - Phone:317-876-3216
Mailing Address - Fax:
Practice Address - Street 1:9645 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-1722
Practice Address - Country:US
Practice Address - Phone:773-239-2734
Practice Address - Fax:773-239-2784
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36000521A2255A2300X
IL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer