Provider Demographics
NPI:1770801334
Name:GRUBEN, JULIE REDDELL (DC)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:REDDELL
Last Name:GRUBEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:JULIE
Other - Middle Name:REDDELL
Other - Last Name:GRUBEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:515 W MAIN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-8000
Mailing Address - Country:US
Mailing Address - Phone:972-908-3322
Mailing Address - Fax:
Practice Address - Street 1:515 W MAIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-8000
Practice Address - Country:US
Practice Address - Phone:972-908-3322
Practice Address - Fax:972-908-3341
Is Sole Proprietor?:No
Enumeration Date:2010-05-06
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11448111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor