Provider Demographics
NPI:1326099144
Name:DUQUE, PABLO FELIPE (DC)
Entity Type:Individual
Prefix:
First Name:PABLO
Middle Name:FELIPE
Last Name:DUQUE
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 1:1080 W F ST
Mailing Address - Street 2:STE B
Mailing Address - City:OAKDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95361-3632
Mailing Address - Country:US
Mailing Address - Phone:209-848-8861
Mailing Address - Fax:209-848-8864
Practice Address - Street 1:1080 W F ST
Practice Address - Street 2:STE B
Practice Address - City:OAKDALE
Practice Address - State:CA
Practice Address - Zip Code:95361-3632
Practice Address - Country:US
Practice Address - Phone:209-848-8861
Practice Address - Fax:209-848-8864
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25053111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0250530Medicare ID - Type Unspecified