Provider Demographics
NPI:1811092430
Name:STRUBLE, MICHAEL D (DC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:STRUBLE
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 1:4883 PALM COAST PKWY NW UNIT 4
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-3675
Mailing Address - Country:US
Mailing Address - Phone:386-445-6565
Mailing Address - Fax:386-445-4481
Practice Address - Street 1:4883 PALM COAST PKWY NW UNIT 4
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-3675
Practice Address - Country:US
Practice Address - Phone:386-445-6565
Practice Address - Fax:386-445-4481
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8753111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL89713OtherBCBS
FL89713OtherBCBS
FL89713ZMedicare PIN