Provider Demographics
NPI:1083780670
Name:RUBERT CHIROPRACTIC LTD
Entity Type:Organization
Organization Name:RUBERT CHIROPRACTIC LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:A
Authorized Official - Last Name:RUBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-484-6444
Mailing Address - Street 1:W1185 MCCRAE RD
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:WI
Mailing Address - Zip Code:53932
Mailing Address - Country:US
Mailing Address - Phone:920-484-6444
Mailing Address - Fax:920-484-6450
Practice Address - Street 1:W1185 MCCRAE RD
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:WI
Practice Address - Zip Code:53932
Practice Address - Country:US
Practice Address - Phone:920-484-6444
Practice Address - Fax:920-484-6450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3105111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
35500Medicare ID - Type Unspecified