Provider Demographics
NPI:1699749622
Name:LUBKEMAN, ROY (DC)
Entity type:Individual
Prefix:DR
First Name:ROY
Middle Name:
Last Name:LUBKEMAN
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 1:1016 NE KAMIES LN
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50021-6759
Mailing Address - Country:US
Mailing Address - Phone:515-963-9715
Mailing Address - Fax:515-963-9716
Practice Address - Street 1:2005 S ANKENY BLVD
Practice Address - Street 2:SUITE 600
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-5427
Practice Address - Country:US
Practice Address - Phone:515-963-9715
Practice Address - Fax:515-963-9716
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA06104111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2185603Medicaid
IAU69126Medicare UPIN
IAI15795Medicare ID - Type Unspecified
IAI7078Medicare ID - Type UnspecifiedARBOR VITAE