Provider Demographics
NPI:1093880007
Name:DUBOIS, JOHN E III (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:E
Last Name:DUBOIS
Suffix:III
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 1:9 BEAVER DR
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-2401
Mailing Address - Country:US
Mailing Address - Phone:814-375-9721
Mailing Address - Fax:814-375-9721
Practice Address - Street 1:9 BEAVER DR
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-2401
Practice Address - Country:US
Practice Address - Phone:814-375-9721
Practice Address - Fax:814-375-9721
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002914L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009923600001Medicaid
PAT27044Medicare UPIN
PA009325Medicare ID - Type Unspecified