Provider Demographics
NPI:1730289521
Name:KAUBISCH, GUS VERNON JR (DC)
Entity Type:Individual
Prefix:DR
First Name:GUS
Middle Name:VERNON
Last Name:KAUBISCH
Suffix:JR
Gender:F
Credentials:DC
Other - Prefix:
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Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1708111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
U02790Medicare UPIN