Provider Demographics
NPI:1073604450
Name:DUBOIS, BETH J (DC)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:J
Last Name:DUBOIS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 E BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-2120
Mailing Address - Country:US
Mailing Address - Phone:315-342-6300
Mailing Address - Fax:315-342-6302
Practice Address - Street 1:55 E BRIDGE ST
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-2120
Practice Address - Country:US
Practice Address - Phone:315-342-6300
Practice Address - Fax:315-342-6302
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009932-1111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX009932-1OtherLIC NUMBER
NYC09932-7BOtherWORKERS COMPENSATION
NYC09932-7BOtherWORKERS COMPENSATION
NYCC9932-7BMedicare ID - Type Unspecified