Provider Demographics
NPI:1881637528
Name:RUBLEY, TODD S
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:S
Last Name:RUBLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1560
Mailing Address - Country:US
Mailing Address - Phone:740-441-1949
Mailing Address - Fax:740-446-5982
Practice Address - Street 1:280 PATTONSVILLE ROAD
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631
Practice Address - Country:US
Practice Address - Phone:740-395-8805
Practice Address - Fax:740-395-8855
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3104111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
001714121OtherMOUNTAIN STATE BCBS
000000186391OtherANTHEM BCBS
OH310917085150OtherCARESOURCE MEDICAID
OH000000185255OtherUNISON MEDICAID
350050255OtherRR MEDICARE
WV2204004000Medicaid
OH2216757OtherMOLINA MEDICAID
350050255OtherRR MEDICARE
U74653Medicare UPIN