Provider Demographics
NPI:1366890915
Name:LUBBE, JEROME (DC)
Entity type:Individual
Prefix:
First Name:JEROME
Middle Name:
Last Name:LUBBE
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 1:1950 SPECTRUM CIR SE
Mailing Address - Street 2:SUITE B-200
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8479
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1950 SPECTRUM CIR SE
Practice Address - Street 2:SUITE B-200
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8479
Practice Address - Country:US
Practice Address - Phone:404-334-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-24
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13069111NN0400X
GACHIR009501111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology