Provider Demographics
NPI:1659409274
Name:HUBBARD, CHRISTA GOODMAN (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTA
Middle Name:GOODMAN
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 23RD ST NW
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58703-1726
Mailing Address - Country:US
Mailing Address - Phone:701-837-9355
Mailing Address - Fax:701-837-0243
Practice Address - Street 1:408 20TH AVE SW
Practice Address - Street 2:SUITE 102
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-6493
Practice Address - Country:US
Practice Address - Phone:701-837-9355
Practice Address - Fax:701-837-0243
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND791111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor