Individual
JACOB VANLUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
13411 INDIANA ST, GRABILL, IN 46741-9435
(260) 443-9454
Mailing address
PO BOX 203, GRABILL, IN 46741-0203
(260) 443-9454
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/04/2022
Last updated
05/30/2024
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