Provider Demographics
NPI:1598921751
Name:KAUBISCH CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:KAUBISCH CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GUS
Authorized Official - Middle Name:VERNON
Authorized Official - Last Name:KAUBISCH
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:218-547-1775
Mailing Address - Street 1:PO BOX 852
Mailing Address - Street 2:
Mailing Address - City:WALKER
Mailing Address - State:MN
Mailing Address - Zip Code:56484-0852
Mailing Address - Country:US
Mailing Address - Phone:218-547-1775
Mailing Address - Fax:218-547-1765
Practice Address - Street 1:207 6TH ST. SO,
Practice Address - Street 2:
Practice Address - City:WALKER
Practice Address - State:MN
Practice Address - Zip Code:56484-0852
Practice Address - Country:US
Practice Address - Phone:218-547-1775
Practice Address - Fax:218-547-1765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1708111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN622827500Medicaid
1730289521OtherNPI
MN622827500Medicaid
1730289521OtherNPI