Provider Demographics
NPI:1184685216
Name:RUBIN, PAUL ERIC (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ERIC
Last Name:RUBIN
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 1:1420 WALNUT ST STE 1404
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-4014
Mailing Address - Country:US
Mailing Address - Phone:215-972-0307
Mailing Address - Fax:215-972-0308
Practice Address - Street 1:1420 WALNUT ST STE 1404
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-4014
Practice Address - Country:US
Practice Address - Phone:215-972-0307
Practice Address - Fax:215-972-0308
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008779111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA078950Medicare ID - Type Unspecified