Provider Demographics
NPI:1023197324
Name:HUBBARD, MARC C (DC)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:C
Last Name:HUBBARD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 N EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-1604
Mailing Address - Country:US
Mailing Address - Phone:314-361-6400
Mailing Address - Fax:314-361-2230
Practice Address - Street 1:504 N EUCLID AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-1604
Practice Address - Country:US
Practice Address - Phone:314-361-6400
Practice Address - Fax:314-361-2230
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005032ZE111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000031017Medicare ID - Type Unspecified