1154477669 NPI number — DR. ROXANNE BETH HUBLER D.C.

Table of content: DR. ROXANNE BETH HUBLER D.C. (NPI 1154477669)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154477669 NPI number — DR. ROXANNE BETH HUBLER D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUBLER
Provider First Name:
ROXANNE
Provider Middle Name:
BETH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VAN DEN BERGHE
Provider Other First Name:
ROXANNE
Provider Other Middle Name:
BETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1154477669
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/23/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 15
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TIPTON
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52772
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
563-370-5528
Provider Business Mailing Address Fax Number:
563-886-3555

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
707 E. 7TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TIPTON
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52772
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
563-370-5528
Provider Business Practice Location Address Fax Number:
563-886-3555
Provider Enumeration Date:
01/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  06950 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0747881 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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