Provider Demographics
NPI:1235137639
Name:DUBOIS, DUSTY D (BS, DC)
Entity Type:Individual
Prefix:
First Name:DUSTY
Middle Name:D
Last Name:DUBOIS
Suffix:
Gender:F
Credentials:BS, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1286
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98041-1286
Mailing Address - Country:US
Mailing Address - Phone:425-770-1321
Mailing Address - Fax:
Practice Address - Street 1:10024 MAIN ST
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-3424
Practice Address - Country:US
Practice Address - Phone:425-770-1321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-09
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3632111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AB10961Medicare ID - Type Unspecified
U76527Medicare UPIN