Provider Demographics
NPI:1578633202
Name:STREBLOW, JONATHON MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:JONATHON
Middle Name:MICHAEL
Last Name:STREBLOW
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 55
Mailing Address - Street 2:715 CHRISTEL DR
Mailing Address - City:VALDERS
Mailing Address - State:WI
Mailing Address - Zip Code:54245
Mailing Address - Country:US
Mailing Address - Phone:920-775-9666
Mailing Address - Fax:920-775-9791
Practice Address - Street 1:715 CHRISTEL DR
Practice Address - Street 2:
Practice Address - City:VALDERS
Practice Address - State:WI
Practice Address - Zip Code:54245
Practice Address - Country:US
Practice Address - Phone:920-775-9666
Practice Address - Fax:920-775-9791
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3440 012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38944800Medicaid
00003575Z0001Medicare ID - Type Unspecified
U65827Medicare UPIN