Provider Demographics
NPI:1962789545
Name:RUBLE, ERIC BENJAMIN (DC)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:BENJAMIN
Last Name:RUBLE
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 1:1437 W MONTROSE AVE
Mailing Address - Street 2:A
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-1348
Mailing Address - Country:US
Mailing Address - Phone:773-561-7966
Mailing Address - Fax:773-935-6022
Practice Address - Street 1:1437 W MONTROSE AVE
Practice Address - Street 2:A
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-1348
Practice Address - Country:US
Practice Address - Phone:773-561-7966
Practice Address - Fax:773-935-6022
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL38.11987111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner