Provider Demographics
NPI:1730295460
Name:HUBER, K PETER (DC)
Entity Type:Individual
Prefix:
First Name:K PETER
Middle Name:
Last Name:HUBER
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 1:1502 SAINT MARKS PLZ
Mailing Address - Street 2:#4
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-6409
Mailing Address - Country:US
Mailing Address - Phone:209-957-6555
Mailing Address - Fax:209-957-6568
Practice Address - Street 1:1502 SAINT MARKS PLZ
Practice Address - Street 2:#4
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6409
Practice Address - Country:US
Practice Address - Phone:209-957-6555
Practice Address - Fax:209-957-6568
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17198111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0171980Medicare UPIN
CADC0171980Medicare ID - Type Unspecified
CA6018330001Medicare NSC