Provider Demographics
NPI:1871957860
Name:JUBERT, NICOLAS (DC)
Entity type:Individual
Prefix:DR
First Name:NICOLAS
Middle Name:
Last Name:JUBERT
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 1:3925 CHAIN BRIDGE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-3938
Mailing Address - Country:US
Mailing Address - Phone:703-890-2222
Mailing Address - Fax:
Practice Address - Street 1:3925 CHAIN BRIDGE RD STE 101
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-3938
Practice Address - Country:US
Practice Address - Phone:703-890-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-06
Last Update Date:2023-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002898A111N00000X
VA0104557936111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100185720AMedicaid
INT34935Medicare UPIN