Provider Demographics
NPI:1396965406
Name:HUBLER, RUSSELL C (DC)
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:C
Last Name:HUBLER
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 1:3 MAIN ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:EASTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02642-2169
Mailing Address - Country:US
Mailing Address - Phone:508-744-3648
Mailing Address - Fax:508-744-3649
Practice Address - Street 1:3 MAIN ST UNIT 2
Practice Address - Street 2:
Practice Address - City:EASTHAM
Practice Address - State:MA
Practice Address - Zip Code:02642-2169
Practice Address - Country:US
Practice Address - Phone:508-744-3648
Practice Address - Fax:508-744-3649
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-30
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2113111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110030509AMedicaid
MA351951OtherHARVARD PILGRIM HEALTH
704353OtherUNITED HEALTHCARE ACN GRO
MAY36492OtherBCBS OF MA
MAY45122Medicare PIN
704353OtherUNITED HEALTHCARE ACN GRO