Provider Demographics
NPI:1083739841
Name:SCOTT A DUBRUL, CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:SCOTT A DUBRUL, CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DUBRUL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-781-9155
Mailing Address - Street 1:1422 MONTEREY ST STE A201
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-2954
Mailing Address - Country:US
Mailing Address - Phone:805-781-9155
Mailing Address - Fax:805-781-0104
Practice Address - Street 1:1422 MONTEREY ST STE A201
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2954
Practice Address - Country:US
Practice Address - Phone:805-781-9155
Practice Address - Fax:805-781-0104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC22650111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA570498505OtherSS # & OLD TAX
CA570498505OtherSS # & OLD TAX
CAU44119Medicare UPIN