Healthcare Provider Details

I. General information

NPI: 1366570467
Provider Name (Legal Business Name): JUDE KOBLA GBEDDIE DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1821 UNIVERSITY AVE SUITE # S-106 UNIVERSAL CHIROPRACTIC HEALTH CLINIC,
ST PAUL MN
55104
US

IV. Provider business mailing address

7627 PONDS EDGE PATH
SAVAGE MN
55378-4704
US

V. Phone/Fax

Practice location:
  • Phone: 651-647-9100
  • Fax:
Mailing address:
  • Phone: 612-483-3282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4794
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: