Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 38MC00770600 | NJ |
NPI | 1003436221 |
---|---|
Provider Name | Dr. Stephen P Struble JR. |
First Address | Galloway, NJ 08205-9761 |
Second Address | Galloway, NJ 08205-9761 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2020 |
Last Update Date | 17/04/2020 |