Healthcare Provider Details

I. General information

NPI: 1528129905
Provider Name (Legal Business Name): PAUL DAVID RUBERT DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 05/23/2023
Certification Date: 05/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 S WALES ST
HUSTISFORD WI
53034
US

IV. Provider business mailing address

PO BOX 325
HUSTISFORD WI
53034-0325
US

V. Phone/Fax

Practice location:
  • Phone: 920-349-3233
  • Fax: 420-349-3933
Mailing address:
  • Phone: 920-349-3233
  • Fax: 920-349-3933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3728012
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: