Provider Demographics
NPI:1558640649
Name:DUBBELDE, NICOLAAS JAMES THEODORE (DC)
Entity Type:Individual
Prefix:DR
First Name:NICOLAAS
Middle Name:JAMES THEODORE
Last Name:DUBBELDE
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 1:1712 JAMES DR
Mailing Address - Street 2:
Mailing Address - City:NORTH MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56003-1804
Mailing Address - Country:US
Mailing Address - Phone:507-385-2000
Mailing Address - Fax:507-385-1933
Practice Address - Street 1:1712 JAMES DR
Practice Address - Street 2:
Practice Address - City:NORTH MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56003-1804
Practice Address - Country:US
Practice Address - Phone:507-385-2000
Practice Address - Fax:507-385-1933
Is Sole Proprietor?:No
Enumeration Date:2011-08-08
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5570111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor