Provider Demographics
NPI:1790904449
Name:RUBY, EDWIN JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:JOHN
Last Name:RUBY
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 1:201 SHADY LANE DR
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-6813
Mailing Address - Country:US
Mailing Address - Phone:386-736-2345
Mailing Address - Fax:
Practice Address - Street 1:3120 SW 27TH AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-8458
Practice Address - Country:US
Practice Address - Phone:352-237-0637
Practice Address - Fax:352-237-8457
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9328111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology