Healthcare Provider Details

I. General information

NPI: 1487664694
Provider Name (Legal Business Name): HUBER CHIROPRACTIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 01/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1953 1ST AVE SE SUITE C-6
CEDAR RAPIDS IA
52402-5328
US

IV. Provider business mailing address

215 3RD AVE SUITE 1
CEDAR RAPIDS IA
52404
US

V. Phone/Fax

Practice location:
  • Phone: 319-298-1234
  • Fax: 319-298-1235
Mailing address:
  • Phone: 319-298-1234
  • Fax: 319-298-1235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number06432
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1250118
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

Name: DR. DAVID AUGUSTINE HUBER
Title or Position: OWNER/ CEO
Credential:
Phone: 319-298-1234