Provider Demographics
NPI:1457332371
Name:RUBADUE-DOI, THERESA MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:MARIE
Last Name:RUBADUE-DOI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 NW YORK DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-1572
Mailing Address - Country:US
Mailing Address - Phone:541-388-2429
Mailing Address - Fax:541-388-2439
Practice Address - Street 1:628 NW YORK DR STE 104
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-1572
Practice Address - Country:US
Practice Address - Phone:541-388-2429
Practice Address - Fax:541-388-2439
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27 1951111N00000X
OR5104111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR117193Medicare UPIN
ORR168758Medicare UPIN
OR117193Medicare PIN
ORT05993Medicare UPIN