Healthcare Provider Details

I. General information

NPI: 1194790568
Provider Name (Legal Business Name): WAYNE ROBERT HUBER JR. D.C, C.C.S.P
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 E FIGZEL CT #104
TEA SD
57064-2276
US

IV. Provider business mailing address

725 E FIGZEL CT #104
TEA SD
57064-2276
US

V. Phone/Fax

Practice location:
  • Phone: 605-498-5100
  • Fax: 605-498-5101
Mailing address:
  • Phone: 605-498-5100
  • Fax: 605-498-5101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberSD935
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: