Provider Demographics
NPI:1386835122
Name:KUBECKA, DWAYNE A (DC)
Entity Type:Individual
Prefix:DR
First Name:DWAYNE
Middle Name:A
Last Name:KUBECKA
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 1:2334 HWY 361
Mailing Address - Street 2:SUITE 162
Mailing Address - City:INGLESIDE
Mailing Address - State:TX
Mailing Address - Zip Code:78362-4127
Mailing Address - Country:US
Mailing Address - Phone:361-776-0030
Mailing Address - Fax:361-776-0731
Practice Address - Street 1:2334 HWY 361
Practice Address - Street 2:SUITE 162
Practice Address - City:INGLESIDE
Practice Address - State:TX
Practice Address - Zip Code:78362-4127
Practice Address - Country:US
Practice Address - Phone:361-776-0030
Practice Address - Fax:361-776-0731
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-07
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6561111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5613511OtherAETNA #
TX8AJ308OtherBLUE CROSS BLUE SHIELD
TX5613511OtherAETNA #