MEDICARE: RUBIO CHIROPRACTIC PA

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	6007	TX

General Provider Information

NPI Number	:	1720261159
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RUBIO CHIROPRACTIC PA

Provider Business Mailing Address
First Line	:	PO BOX 35328
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235-0328
Country	:	US
Telephone Number	:	214-654-0636
Fax Number	:	214-654-0637

Provider Business Practice Location Address
First Line	:	2928 INWOOD RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235-7518
Country	:	US
Telephone Number	:	214-654-0636
Fax Number	:	214-654-0636

Authorized Official
Title or Position	:	PROPRIETOR
Name	:	TOM RUBIO IV
Credential	:	DC
Telephone Number	:	214-654-0636

Provider Enumeration Date	:	12/07/2007
Last Update Date	:	12/07/2007

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