Provider Demographics
NPI:1477633485
Name:RUBIO, ERNEST JR (DC)
Entity Type:Individual
Prefix:MR
First Name:ERNEST
Middle Name:
Last Name:RUBIO
Suffix:JR
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 1:14960 BEAR VALLEY RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-9248
Mailing Address - Country:US
Mailing Address - Phone:760-241-0018
Mailing Address - Fax:760-241-0774
Practice Address - Street 1:14960 BEAR VALLEY RD
Practice Address - Street 2:SUITE C
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-9248
Practice Address - Country:US
Practice Address - Phone:760-241-0018
Practice Address - Fax:760-241-0774
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0199680111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA330400108Medicare ID - Type Unspecified