Provider Demographics
NPI:1336192889
Name:KUBO-MANLEY, K ROBYN (DC)
Entity Type:Individual
Prefix:
First Name:K ROBYN
Middle Name:
Last Name:KUBO-MANLEY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 MERIDIAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-5210
Mailing Address - Country:US
Mailing Address - Phone:408-448-4004
Mailing Address - Fax:408-448-4006
Practice Address - Street 1:1213 MERIDIAN AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-5210
Practice Address - Country:US
Practice Address - Phone:408-448-4004
Practice Address - Fax:408-448-4006
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24867111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0248670Medicare ID - Type Unspecified