Provider Demographics
NPI:1134213580
Name:THAUBERGER, DEVIN J (DC)
Entity type:Individual
Prefix:DR
First Name:DEVIN
Middle Name:J
Last Name:THAUBERGER
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 1:11311 WOODED BRANCH LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40291-3599
Mailing Address - Country:US
Mailing Address - Phone:502-500-7068
Mailing Address - Fax:502-961-0392
Practice Address - Street 1:8511 PRESTON HWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-5301
Practice Address - Country:US
Practice Address - Phone:502-969-7246
Practice Address - Fax:502-961-0392
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4782111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0983801OtherMEDICARE ID-TYPE SPECIFIED
KY000000379843Medicare UPIN