Provider Demographics
NPI:1386830834
Name:RUBIN, DREW (DC)
Entity Type:Individual
Prefix:
First Name:DREW
Middle Name:
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 1:255 VILLAGE PKWY NE
Mailing Address - Street 2:SUITE 620
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-4158
Mailing Address - Country:US
Mailing Address - Phone:770-937-6300
Mailing Address - Fax:770-937-9296
Practice Address - Street 1:255 VILLAGE PKWY NE
Practice Address - Street 2:SUITE 620
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-4158
Practice Address - Country:US
Practice Address - Phone:770-937-6300
Practice Address - Fax:770-937-9296
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6579111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCGKTMedicare PIN
T92302Medicare UPIN