Provider Demographics
NPI:1780615195
Name:WUBBENA, ANITA LYNN (DC)
Entity type:Individual
Prefix:DR
First Name:ANITA
Middle Name:LYNN
Last Name:WUBBENA
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 1:18 LINCOLN AVENUE
Mailing Address - Street 2:
Mailing Address - City:ELDRIDGE
Mailing Address - State:IA
Mailing Address - Zip Code:52748-9698
Mailing Address - Country:US
Mailing Address - Phone:563-285-8434
Mailing Address - Fax:563-285-8453
Practice Address - Street 1:18 LINCOLN AVENUE
Practice Address - Street 2:
Practice Address - City:ELDRIDGE
Practice Address - State:IA
Practice Address - Zip Code:52748-9698
Practice Address - Country:US
Practice Address - Phone:563-285-8434
Practice Address - Fax:563-285-8453
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05888111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA48089OtherBCBS
IA1126730Medicaid
243533OtherMIDLANDS CHOICE
IA1126730Medicaid