Provider Demographics
NPI:1295743474
Name:RUEBEN, BRIAN (DC)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:
Last Name:RUEBEN
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 1:61535 S HIGHWAY 97 STE 18
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-2156
Mailing Address - Country:US
Mailing Address - Phone:541-383-4255
Mailing Address - Fax:541-383-4915
Practice Address - Street 1:61535 S HIGHWAY 97 STE 18
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-2156
Practice Address - Country:US
Practice Address - Phone:541-343-4255
Practice Address - Fax:541-383-4915
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27-3266111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
1295743474OtherNPI