Provider Demographics
NPI:1528129905
Name:RUBERT, PAUL DAVID (DC)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:DAVID
Last Name:RUBERT
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:PO BOX 325
Mailing Address - Street 2:
Mailing Address - City:HUSTISFORD
Mailing Address - State:WI
Mailing Address - Zip Code:53034-0325
Mailing Address - Country:US
Mailing Address - Phone:920-349-3233
Mailing Address - Fax:920-349-3933
Practice Address - Street 1:215 S WALES ST
Practice Address - Street 2:
Practice Address - City:HUSTISFORD
Practice Address - State:WI
Practice Address - Zip Code:53034
Practice Address - Country:US
Practice Address - Phone:920-349-3233
Practice Address - Fax:420-349-3933
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3728012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
350049198OtherRRMC
350049198OtherRRMC
U82817Medicare UPIN