Provider Demographics
NPI:1891832812
Name:BRUBAKER, JEREMY E (DC)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:E
Last Name:BRUBAKER
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 1:14097 PINE ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-3110
Mailing Address - Country:US
Mailing Address - Phone:814-590-4411
Mailing Address - Fax:
Practice Address - Street 1:14097 PINE ISLAND DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-3110
Practice Address - Country:US
Practice Address - Phone:814-590-4411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2021-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009292111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1728590OtherHIGHMARK BC BS
PA094311ULAMedicare ID - Type Unspecified
PAV06446Medicare UPIN