Provider Demographics
NPI:1447582150
Name:DUBY, BRIAN D (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:D
Last Name:DUBY
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 1:1125 SE MADISON ST STE 100A
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-3600
Mailing Address - Country:US
Mailing Address - Phone:503-935-9488
Mailing Address - Fax:971-260-4989
Practice Address - Street 1:1125 SE MADISON ST STE 100A
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-3600
Practice Address - Country:US
Practice Address - Phone:503-935-9488
Practice Address - Fax:971-260-4989
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-04
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3235111NN1001X, 111NR0400X, 111NI0900X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111NI0900XChiropractic ProvidersChiropractorInternist