Provider Demographics
NPI:1144952607
Name:TUBAUGH FAMILY CHIROPRACTIC CLINIC
Entity type:Organization
Organization Name:TUBAUGH FAMILY CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:PRATER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-437-4433
Mailing Address - Street 1:1114 N HAYNES AVE
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52544-1134
Mailing Address - Country:US
Mailing Address - Phone:641-437-4433
Mailing Address - Fax:
Practice Address - Street 1:1114 N HAYNES AVE
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:IA
Practice Address - Zip Code:52544-1134
Practice Address - Country:US
Practice Address - Phone:641-437-4433
Practice Address - Fax:641-437-7333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-24
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0232264Medicaid