Provider Demographics
NPI:1740377142
Name:TREMBA, MICHAEL DAVID (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DAVID
Last Name:TREMBA
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 1:1000 13TH ST E STE D
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35404-3809
Mailing Address - Country:US
Mailing Address - Phone:205-409-8469
Mailing Address - Fax:205-462-3972
Practice Address - Street 1:1000 13TH ST E STE D
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404
Practice Address - Country:US
Practice Address - Phone:205-409-8469
Practice Address - Fax:205-462-3972
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3837012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI200383368012OtherBCBS
P00052996OtherRAILROAD MEDICARE