Provider Demographics
NPI:1922334077
Name:ADVANCED CHIROPRACTIC OF DUBOIS
Entity Type:Organization
Organization Name:ADVANCED CHIROPRACTIC OF DUBOIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/ CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:MCGOWAN
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-371-7211
Mailing Address - Street 1:1116 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-2904
Mailing Address - Country:US
Mailing Address - Phone:817-371-7211
Mailing Address - Fax:814-371-7238
Practice Address - Street 1:1116 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-2904
Practice Address - Country:US
Practice Address - Phone:817-371-7211
Practice Address - Fax:814-371-7238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-26
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008784111N00000X
PADC008741111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty