Provider Demographics
NPI:1932375508
Name:TUBB FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:TUBB FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:I
Authorized Official - Last Name:TUBB
Authorized Official - Suffix:
Authorized Official - Credentials:D C, CCSP
Authorized Official - Phone:937-567-7990
Mailing Address - Street 1:145 W FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4701
Mailing Address - Country:US
Mailing Address - Phone:937-567-7990
Mailing Address - Fax:937-567-7990
Practice Address - Street 1:145 W FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-4701
Practice Address - Country:US
Practice Address - Phone:937-567-7990
Practice Address - Fax:937-567-7990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2075111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0239549Medicaid
OHU46171Medicare UPIN
OH9337081Medicare PIN