Provider Demographics
NPI:1679782114
Name:HUBER CHIROPRACTIC, P.A.
Entity type:Organization
Organization Name:HUBER CHIROPRACTIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:C
Authorized Official - Last Name:HUBER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:321-951-9599
Mailing Address - Street 1:2080 MEADOWLANE AVE
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-4950
Mailing Address - Country:US
Mailing Address - Phone:321-951-9599
Mailing Address - Fax:321-951-9593
Practice Address - Street 1:2080 MEADOWLANE AVE
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-4950
Practice Address - Country:US
Practice Address - Phone:321-951-9599
Practice Address - Fax:321-951-9593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7837111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE5667ZMedicare ID - Type Unspecified