Healthcare Provider Details

I. General information

NPI: 1124231725
Provider Name (Legal Business Name): LUBOVICH CHIROPRACTIC, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 MAIN ST
ELKO MN
55020-9701
US

IV. Provider business mailing address

10880 175TH CT W STE 120
LAKEVILLE MN
55044-7493
US

V. Phone/Fax

Practice location:
  • Phone: 952-461-5110
  • Fax:
Mailing address:
  • Phone: 952-898-4900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2726
License Number StateMN

VIII. Authorized Official

Name: DR. ROBERT CLARENCE LUBOVICH
Title or Position: OWNER
Credential: C.D.
Phone: 952-898-4900