Provider Demographics
NPI:1063474310
Name:STUBER CHIROPRACTIC & ACUPUNCTURE LLC
Entity Type:Organization
Organization Name:STUBER CHIROPRACTIC & ACUPUNCTURE LLC
Other - Org Name:EXTREME WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:STUBER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:407-566-9814
Mailing Address - Street 1:1530 CELEBRATION BLVD
Mailing Address - Street 2:SUITE 407
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-5164
Mailing Address - Country:US
Mailing Address - Phone:407-566-9814
Mailing Address - Fax:407-566-9812
Practice Address - Street 1:1530 CELEBRATION BLVD
Practice Address - Street 2:SUITE 407
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-5164
Practice Address - Country:US
Practice Address - Phone:407-566-9814
Practice Address - Fax:407-566-9812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-03
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6245111N00000X, 171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22591XMedicare PIN
FLU11081Medicare UPIN