Provider Demographics
NPI:1336215920
Name:RUBERT, JILL ANN (DC)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:ANN
Last Name:RUBERT
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:W1185 MCCRAE RD
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:WI
Mailing Address - Zip Code:53932
Mailing Address - Country:US
Mailing Address - Phone:920-484-6444
Mailing Address - Fax:920-484-6450
Practice Address - Street 1:W1185 MCCRAE RD
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:WI
Practice Address - Zip Code:53932
Practice Address - Country:US
Practice Address - Phone:920-484-6444
Practice Address - Fax:920-484-6450
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3105111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
350049198OtherRR MC
350049198OtherRR MC
U48619Medicare UPIN