=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184312621
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRETT M SCHUBERT DC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/24/2023
-----------------------------------------------------
Last Update Date | 04/24/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3830 PAXTON AVE
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45209-2399
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-827-9032
-----------------------------------------------------
Fax | 513-827-9297
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7679 ANDERSON OAKS DR
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45255-3075
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-509-1928
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC-05251
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------