MEDICARE: PAUL J HUBERT CH

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	X0053521	NY

General Provider Information

NPI Number	:	1770680498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL J HUBERT CH

Provider Business Mailing Address
First Line	:	155 FIRE ISLAND AVE
Second Line	:
City	:	BABYLON
State	:	NY
Zip	:	11702-3909
Country	:	US
Telephone Number	:	631-669-0956
Fax Number	:	631-669-0967

Provider Business Practice Location Address
First Line	:	155 FIRE ISLAND AVE
Second Line	:
City	:	BABYLON
State	:	NY
Zip	:	11702-3909
Country	:	US
Telephone Number	:	631-669-0956
Fax Number	:	631-669-0967

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2006
Last Update Date	:	12/13/2007

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