Provider Demographics
NPI:1225056096
Name:KUBASKO, CHARLES B (DC)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:B
Last Name:KUBASKO
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 1:4517 LEAD MINE RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-3326
Mailing Address - Country:US
Mailing Address - Phone:919-781-8830
Mailing Address - Fax:919-781-1678
Practice Address - Street 1:4517 LEAD MINE RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-3326
Practice Address - Country:US
Practice Address - Phone:919-781-8830
Practice Address - Fax:919-781-1678
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1346111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC08596OtherBLUE CROSS BLUE SHIELD
NC8908596Medicaid
NC08596OtherBLUE CROSS BLUE SHIELD
T64483Medicare UPIN