Healthcare Provider Details

I. General information

NPI: 1891556197
Provider Name (Legal Business Name): RUBIN CHIROPRACTIC PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2024
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31360 VIA COLINAS STE 104
WESTLAKE VILLAGE CA
91362-6821
US

IV. Provider business mailing address

1323 CALLE DURAZNO
THOUSAND OAKS CA
91360-6711
US

V. Phone/Fax

Practice location:
  • Phone: 805-428-6208
  • Fax:
Mailing address:
  • Phone: 805-428-6208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: RYAN TIMOTHY RUBIN
Title or Position: OWNER
Credential: DC
Phone: 805-738-8235