Provider Demographics
NPI:1548453772
Name:KUBOVEC CHIROPRACTIC, INC
Entity type:Organization
Organization Name:KUBOVEC CHIROPRACTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:KUBOVEC
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:319-438-1089
Mailing Address - Street 1:PO BOX 357
Mailing Address - Street 2:
Mailing Address - City:CENTRAL CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52214-0357
Mailing Address - Country:US
Mailing Address - Phone:319-438-1089
Mailing Address - Fax:319-438-1091
Practice Address - Street 1:302 EAST MAPLE ST.
Practice Address - Street 2:
Practice Address - City:CENTRAL CITY
Practice Address - State:IA
Practice Address - Zip Code:52214
Practice Address - Country:US
Practice Address - Phone:319-438-1089
Practice Address - Fax:319-438-1091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06252111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI8328Medicare PIN
IAI8327Medicare PIN