1386835122 NPI number — DR. DWAYNE A KUBECKA D.C

Table of content: DR. DWAYNE A KUBECKA D.C (NPI 1386835122)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386835122 NPI number — DR. DWAYNE A KUBECKA D.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KUBECKA
Provider First Name:
DWAYNE
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386835122
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2334 HWY 361
Provider Second Line Business Mailing Address:
SUITE 162
Provider Business Mailing Address City Name:
INGLESIDE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78362-4127
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-776-0030
Provider Business Mailing Address Fax Number:
361-776-0731

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2334 HWY 361
Provider Second Line Business Practice Location Address:
SUITE 162
Provider Business Practice Location Address City Name:
INGLESIDE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78362-4127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-776-0030
Provider Business Practice Location Address Fax Number:
361-776-0731
Provider Enumeration Date:
08/07/2007

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:  6561 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5613511 . This is a "AETNA #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8AJ308 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com