MEDICARE: RUBERT CHIROPRACTIC LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	3105	WI

General Provider Information

NPI Number	:	1083780670
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RUBERT CHIROPRACTIC LTD

Provider Business Mailing Address
First Line	:	W1185 MCCRAE RD
Second Line	:
City	:	FALL RIVER
State	:	WI
Zip	:	53932
Country	:	US
Telephone Number	:	920-484-6444
Fax Number	:	920-484-6450

Provider Business Practice Location Address
First Line	:	W1185 MCCRAE RD
Second Line	:
City	:	FALL RIVER
State	:	WI
Zip	:	53932
Country	:	US
Telephone Number	:	920-484-6444
Fax Number	:	920-484-6450

Authorized Official
Title or Position	:	OWNER PRESIDENT
Name	:	MRS. JILL A RUBERT
Credential	:
Telephone Number	:	920-484-6444

Provider Enumeration Date	:	11/27/2006
Last Update Date	:	08/22/2020

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