Healthcare Provider Details

I. General information

NPI: 1962600593
Provider Name (Legal Business Name): DR. MICHAEL J EBERLE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1603 THIRD STREET
MARYSVILLE WA
98270
US

IV. Provider business mailing address

1603 3RD ST
MARYSVILLE WA
98270-5003
US

V. Phone/Fax

Practice location:
  • Phone: 360-653-7333
  • Fax: 360-653-8566
Mailing address:
  • Phone: 360-653-7333
  • Fax: 360-653-8566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberCH00001466
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: