Provider Demographics
NPI:1447421276
Name:RUBIN, MITCHELL C (DC)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:C
Last Name:RUBIN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:MITCHELL
Other - Middle Name:C
Other - Last Name:RUBIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:8811 JAMAICA AVE
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11421-2039
Mailing Address - Country:US
Mailing Address - Phone:718-847-4222
Mailing Address - Fax:718-847-4222
Practice Address - Street 1:8811 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:NY
Practice Address - Zip Code:11421-2039
Practice Address - Country:US
Practice Address - Phone:718-847-4222
Practice Address - Fax:718-441-4117
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7908111N00000X
NY011570111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor