Provider Demographics
NPI:1568543841
Name:RUBIN, STUART JAY (DC)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:JAY
Last Name:RUBIN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:STUART
Other - Middle Name:J
Other - Last Name:RUBIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:22433 MIDDLEBELT RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-3743
Mailing Address - Country:US
Mailing Address - Phone:248-476-1900
Mailing Address - Fax:248-476-8753
Practice Address - Street 1:22433 MIDDLEBELT RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-3743
Practice Address - Country:US
Practice Address - Phone:248-476-1900
Practice Address - Fax:248-476-8753
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004795111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI142926598Medicaid
MIOF35194Medicare ID - Type UnspecifiedID