Provider Demographics
NPI:1508918715
Name:RUBIN, BURT H (DC)
Entity Type:Individual
Prefix:
First Name:BURT
Middle Name:H
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 1:183 WOODLAND RD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23663
Mailing Address - Country:US
Mailing Address - Phone:757-723-3893
Mailing Address - Fax:757-723-8669
Practice Address - Street 1:183 WOODLAND RD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23663
Practice Address - Country:US
Practice Address - Phone:757-723-3893
Practice Address - Fax:757-723-8669
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA283111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA003127OtherANTHEM
VA003127OtherANTHEM