Provider Demographics
NPI:1063442135
Name:RUBIO, TOM IV (DC)
Entity type:Individual
Prefix:
First Name:TOM
Middle Name:
Last Name:RUBIO
Suffix:IV
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 1:329 CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-6505
Mailing Address - Country:US
Mailing Address - Phone:214-942-8100
Mailing Address - Fax:214-942-8107
Practice Address - Street 1:329 CENTRE ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-6505
Practice Address - Country:US
Practice Address - Phone:214-942-8100
Practice Address - Fax:214-942-8107
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6007111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX605474Medicare ID - Type Unspecified
TXU40620Medicare UPIN