Provider Demographics
NPI:1679684179
Name:HUBBLE, HENRY LEWIS (DC)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:LEWIS
Last Name:HUBBLE
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:PO BOX 1516
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MEDINA
Mailing Address - State:TX
Mailing Address - Zip Code:78055-1516
Mailing Address - Country:US
Mailing Address - Phone:830-896-6020
Mailing Address - Fax:
Practice Address - Street 1:448 SIDNEY BAKER ST S
Practice Address - Street 2:SUITE 101
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-5915
Practice Address - Country:US
Practice Address - Phone:830-896-6020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2694111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0011223-01Medicaid
TX2694OtherSTATE LICENSE NUMBER
TX8113940OtherBLUE LINK NUMBER
TX0011223-01Medicaid
TX8113940OtherBLUE LINK NUMBER