Provider Demographics
NPI:1902966807
Name:MICHAEL STRUBLE, P.A.
Entity type:Organization
Organization Name:MICHAEL STRUBLE, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:STRUBLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:386-445-6565
Mailing Address - Street 1:4883 PALM COAST PKWY NW UNIT 4
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-3675
Mailing Address - Country:US
Mailing Address - Phone:386-445-6565
Mailing Address - Fax:386-445-4481
Practice Address - Street 1:4883 PALM COAST PKWY NW UNIT 4
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-3675
Practice Address - Country:US
Practice Address - Phone:386-445-6565
Practice Address - Fax:386-445-4481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X
FLCH8753111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL97003OtherBCBS
FL97003OtherBCBS
89713Medicare PIN
FLK6026Medicare ID - Type Unspecified