Basic Information
| Provider Information | |||||||||
| NPI: | 1063474310 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | STUBER CHIROPRACTIC & ACUPUNCTURE LLC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | EXTREME WELLNESS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1530 CELEBRATION BLVD | ||||||||
| Address2: | SUITE 407 | ||||||||
| City: | CELEBRATION | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347475164 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4075669814 | ||||||||
| FaxNumber: | 4075669812 | ||||||||
| Practice Location | |||||||||
| Address1: | 1530 CELEBRATION BLVD | ||||||||
| Address2: | SUITE 407 | ||||||||
| City: | CELEBRATION | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347475164 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4075669814 | ||||||||
| FaxNumber: | 4075669812 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2006 | ||||||||
| LastUpdateDate: | 04/07/2010 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | STUBER | ||||||||
| AuthorizedOfficialFirstName: | JULIE | ||||||||
| AuthorizedOfficialMiddleName: | ANN | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4075669814 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | DC | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171100000X | CH6245 | FL | N | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Acupuncturist | 111N00000X | CH6245 | FL | Y | 193200000X MULTI-SPECIALTY GROUP | Chiropractic Providers | Chiropractor |
No ID Information.