Provider Demographics
NPI:1861550881
Name:JUBY CLINIC OF CHIROPRACTIC
Entity type:Organization
Organization Name:JUBY CLINIC OF CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:JUBY
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:704-542-5858
Mailing Address - Street 1:2135 AYRSLEY TOWN BLVD
Mailing Address - Street 2:STE. E
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-3541
Mailing Address - Country:US
Mailing Address - Phone:704-542-5858
Mailing Address - Fax:704-541-3066
Practice Address - Street 1:2135 AYRSLEY TOWN BLVD
Practice Address - Street 2:STE. E
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-3541
Practice Address - Country:US
Practice Address - Phone:704-542-5858
Practice Address - Fax:704-541-3066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1343111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890824JMedicaid
NC7908546Medicaid
NC1508880683OtherNPI TYPE 1
NC1508880683OtherNPI TYPE 1
NC7908546Medicaid