Provider Demographics
NPI:1043380561
Name:HUBERTY, STEVEN L (DC)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:L
Last Name:HUBERTY
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 1:5609 LAMBERT AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBERTVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55301-3917
Mailing Address - Country:US
Mailing Address - Phone:612-616-4338
Mailing Address - Fax:
Practice Address - Street 1:4221 WINNETKA AVE N
Practice Address - Street 2:
Practice Address - City:NEW HOPE
Practice Address - State:MN
Practice Address - Zip Code:55428-4924
Practice Address - Country:US
Practice Address - Phone:763-533-0654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3963111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN240786800Medicaid
U82103Medicare UPIN
350002197Medicare ID - Type Unspecified