Provider Demographics
NPI:1578650131
Name:HUBBARD, MATTHEW ALEXANDER (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:ALEXANDER
Last Name:HUBBARD
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 1:4344 CONVOY ST
Mailing Address - Street 2:SUITE K
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-3737
Mailing Address - Country:US
Mailing Address - Phone:858-279-7300
Mailing Address - Fax:858-279-5535
Practice Address - Street 1:4344 CONVOY ST
Practice Address - Street 2:SUITE K
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-3737
Practice Address - Country:US
Practice Address - Phone:858-279-7300
Practice Address - Fax:858-279-5535
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28496111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC28496Medicare ID - Type UnspecifiedLICENSE NUMBER