Provider Demographics
NPI:1932187978
Name:BUB, JAMES MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MICHAEL
Last Name:BUB
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5445 N KOLB RD
Mailing Address - Street 2:SUITE 141
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85750-0744
Mailing Address - Country:US
Mailing Address - Phone:520-577-3564
Mailing Address - Fax:520-577-4847
Practice Address - Street 1:5445 N KOLB RD
Practice Address - Street 2:SUITE 141
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85750-0744
Practice Address - Country:US
Practice Address - Phone:520-577-3564
Practice Address - Fax:520-577-4847
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ7362111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ82734Medicare PIN
AZZ82732Medicare PIN
AZU33363Medicare UPIN