Provider Demographics
NPI:1124178421
Name:NEBBELING, DAVID P (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:P
Last Name:NEBBELING
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3918 W ST JOE HWY
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-4214
Mailing Address - Country:US
Mailing Address - Phone:517-323-1833
Mailing Address - Fax:517-853-0534
Practice Address - Street 1:3918 W ST JOE HWY
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-4214
Practice Address - Country:US
Practice Address - Phone:517-323-1833
Practice Address - Fax:517-853-0534
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101010112204D00000X
IA02797204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5101010112OtherMI LICENSE
IA02797OtherIA LICENSE
MI421301853OtherTAX ID #