Provider Demographics
NPI:1689933798
Name:WRUBEL, SHAWN JONATHAN (DC)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:JONATHAN
Last Name:WRUBEL
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 1:811 LIVERNOIS ST
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-2308
Mailing Address - Country:US
Mailing Address - Phone:248-439-1017
Mailing Address - Fax:248-439-1017
Practice Address - Street 1:811 LIVERNOIS ST
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-2308
Practice Address - Country:US
Practice Address - Phone:248-439-1017
Practice Address - Fax:248-439-1017
Is Sole Proprietor?:No
Enumeration Date:2012-05-09
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009873111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2301009873OtherSTATE CHIROPRACTIC LICENSE