Provider Demographics
NPI:1811017445
Name:ROBERT L. DUBINICK, DC, PC
Entity Type:Organization
Organization Name:ROBERT L. DUBINICK, DC, PC
Other - Org Name:DUBINICK CHIROPRACTIC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:DUBINICK
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:417-887-9493
Mailing Address - Street 1:1347 S GLENSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-0301
Mailing Address - Country:US
Mailing Address - Phone:417-887-9493
Mailing Address - Fax:417-887-8990
Practice Address - Street 1:1347 S GLENSTONE AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-0301
Practice Address - Country:US
Practice Address - Phone:417-887-9493
Practice Address - Fax:417-887-8990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000031142Medicare PIN
MO990001092Medicare ID - Type UnspecifiedMEDICARE GROUP