Provider Demographics
NPI:1386940963
Name:HUEBL, ELIZABETH HUNTINGTON MATHIS (DC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:HUNTINGTON MATHIS
Last Name:HUEBL
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 1:1136 E RUSHOLME ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-2517
Mailing Address - Country:US
Mailing Address - Phone:563-650-9882
Mailing Address - Fax:
Practice Address - Street 1:1136 E RUSHOLME ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-2517
Practice Address - Country:US
Practice Address - Phone:563-650-9882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-31
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4727-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38995100Medicaid
WI000035980Medicare Oscar/Certification