Healthcare Provider Details

I. General information

NPI: 1164828232
Provider Name (Legal Business Name): JEAN YVES HURTUBISE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2014
Last Update Date: 05/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 TAYLOR AVE
MARYSVILLE OH
43040-9704
US

IV. Provider business mailing address

375 TAYLOR AVE
MARYSVILLE OH
43040-9704
US

V. Phone/Fax

Practice location:
  • Phone: 937-553-9625
  • Fax:
Mailing address:
  • Phone: 937-553-9625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4490
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: