1134364995 NPI number — JULIE STUBRUD DC LLC

Table of content: (NPI 1134364995)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134364995 NPI number — JULIE STUBRUD DC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JULIE STUBRUD DC LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DR. JULIE CHIROPRACTIC AND MASSAGE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134364995
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/02/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6405 SW 38TH ST STE 203
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OCALA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34474-6540
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-390-6133
Provider Business Mailing Address Fax Number:
352-390-6961

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6405 SW 38TH ST STE 203
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OCALA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34474-6540
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-390-6133
Provider Business Practice Location Address Fax Number:
352-390-6961
Provider Enumeration Date:
12/09/2008

Additional Information

Authorized Official

Authorized Official Last Name:
STUBRUD
Authorized Official First Name:
JULIE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
352-390-6133

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CH9380 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9111145 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: BO786A . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 64206 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 382203600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 013001400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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