Provider Demographics
NPI:1972816049
Name:JULIE REDDELL GRUBEN DC PLLC
Entity type:Organization
Organization Name:JULIE REDDELL GRUBEN DC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:REDDELL
Authorized Official - Last Name:GRUBEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-908-3322
Mailing Address - Street 1:515 W MAIN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-8000
Mailing Address - Country:US
Mailing Address - Phone:972-908-3322
Mailing Address - Fax:972-908-3341
Practice Address - Street 1:515 W MAIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-8000
Practice Address - Country:US
Practice Address - Phone:972-908-3322
Practice Address - Fax:972-908-3341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-19
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11448111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty