Provider Demographics
NPI:1639229933
Name:DUBOIS, SARA DANIELLE (DC)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:DANIELLE
Last Name:DUBOIS
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 1:115 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-1082
Mailing Address - Country:US
Mailing Address - Phone:401-228-7122
Mailing Address - Fax:401-228-7144
Practice Address - Street 1:115 CEDAR ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-1082
Practice Address - Country:US
Practice Address - Phone:401-228-7122
Practice Address - Fax:401-228-7144
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3087111N00000X
RIDCP00547111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor