Provider Demographics
NPI:1871767269
Name:RUBERT CHIROPRACTIC INC
Entity type:Organization
Organization Name:RUBERT CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUBERT
Authorized Official - Middle Name:PHILLIP
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-748-0056
Mailing Address - Street 1:44 W 7200 S
Mailing Address - Street 2:STE B
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-3751
Mailing Address - Country:US
Mailing Address - Phone:801-748-0056
Mailing Address - Fax:801-748-0547
Practice Address - Street 1:44 W 7200 S
Practice Address - Street 2:STE B
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-3751
Practice Address - Country:US
Practice Address - Phone:801-748-0056
Practice Address - Fax:801-748-0547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2906261202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT02906261202001OtherREGENCE BCBSU
UT02906261202001OtherREGENCE BCBSU