Provider Demographics
NPI:1134318462
Name:RUBIN CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:RUBIN CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARLEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:RUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:269-343-3575
Mailing Address - Street 1:3808 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49006-2725
Mailing Address - Country:US
Mailing Address - Phone:269-343-3575
Mailing Address - Fax:269-343-3576
Practice Address - Street 1:3808 W MAIN ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49006-2725
Practice Address - Country:US
Practice Address - Phone:269-343-3575
Practice Address - Fax:269-343-3576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301002619111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4719493Medicaid
MI4719493Medicaid
MIOM98440Medicare PIN