Provider Demographics
NPI:1851975759
Name:TRABUE, WILLIAM SUTHERLAND
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:SUTHERLAND
Last Name:TRABUE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3155 AERIAL WAY
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34604-0629
Mailing Address - Country:US
Mailing Address - Phone:352-283-8388
Mailing Address - Fax:
Practice Address - Street 1:1502 MCARTHUR ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-2520
Practice Address - Country:US
Practice Address - Phone:931-723-4878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-07
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH13503111N00000X
TNDC0000003392111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor