Provider Demographics
NPI:1922134659
Name:LUBITZ, BRUCE FRANKLIN (DC)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:FRANKLIN
Last Name:LUBITZ
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 1:2722 W CARLA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-4146
Mailing Address - Country:US
Mailing Address - Phone:480-899-6223
Mailing Address - Fax:480-968-0955
Practice Address - Street 1:2504 S RURAL RD
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-2429
Practice Address - Country:US
Practice Address - Phone:480-968-7767
Practice Address - Fax:480-968-0955
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ888111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ-0085910OtherBLUE CROSS PROVIDER NUMBE
AZZO62384123Medicare ID - Type UnspecifiedPROVIDER NUMBER