Provider Demographics
NPI:1376797340
Name:LA RELLE C PLUBELL CHIROPRACTIC INC
Entity type:Organization
Organization Name:LA RELLE C PLUBELL CHIROPRACTIC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LA RELLE
Authorized Official - Middle Name:CHERE
Authorized Official - Last Name:PLUBELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC, QME
Authorized Official - Phone:530-642-0224
Mailing Address - Street 1:7553 GREEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-3917
Mailing Address - Country:US
Mailing Address - Phone:530-642-0224
Mailing Address - Fax:530-642-0292
Practice Address - Street 1:7553 GREEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-3917
Practice Address - Country:US
Practice Address - Phone:530-642-0224
Practice Address - Fax:530-642-0292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-04
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0230920111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0230920OtherMEDICARE PTAN