Provider Demographics
NPI:1760596548
Name:SCHUBERT, HAROLD JR (DC)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:
Last Name:SCHUBERT
Suffix:JR
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 1:1640 GLEASON ST
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:OH
Mailing Address - Zip Code:45365-3561
Mailing Address - Country:US
Mailing Address - Phone:937-492-4681
Mailing Address - Fax:937-492-7200
Practice Address - Street 1:1640 GLEASON ST
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-3561
Practice Address - Country:US
Practice Address - Phone:937-492-4681
Practice Address - Fax:937-492-7200
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3364111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH480195OtherANTHEM/PIN
OH2432228Medicaid
OHT06722Medicare UPIN
OH2432228Medicaid