Provider Demographics
NPI:1528124005
Name:LUBOVICH, ROBERT CLARENCE (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CLARENCE
Last Name:LUBOVICH
Suffix:
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 1:10880 175TH CT W STE 120
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-7493
Mailing Address - Country:US
Mailing Address - Phone:952-898-4900
Mailing Address - Fax:952-898-7626
Practice Address - Street 1:10880 175TH CT W STE 120
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-7493
Practice Address - Country:US
Practice Address - Phone:952-898-4900
Practice Address - Fax:952-898-7626
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2726111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor