Provider Demographics
NPI:1851729545
Name:DUBOIS, MOXIE
Entity Type:Individual
Prefix:
First Name:MOXIE
Middle Name:
Last Name:DUBOIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 HAIKU RD
Mailing Address - Street 2:#127
Mailing Address - City:HAIKU
Mailing Address - State:HI
Mailing Address - Zip Code:96708-4803
Mailing Address - Country:US
Mailing Address - Phone:808-250-4568
Mailing Address - Fax:
Practice Address - Street 1:810 HAIKU RD
Practice Address - Street 2:#127
Practice Address - City:HAIKU
Practice Address - State:HI
Practice Address - Zip Code:96708-4803
Practice Address - Country:US
Practice Address - Phone:808-579-8525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-16
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT 4759225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist