Provider Demographics
NPI:1275855439
Name:ROUBOS, DANE ARLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:DANE
Middle Name:ARLEN
Last Name:ROUBOS
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 1:987 SISKIYOU BLVD
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-2237
Mailing Address - Country:US
Mailing Address - Phone:541-821-3263
Mailing Address - Fax:
Practice Address - Street 1:987 SISKIYOU BLVD
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-2237
Practice Address - Country:US
Practice Address - Phone:541-821-3263
Practice Address - Fax:541-482-3364
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-15
Last Update Date:2010-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3893111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor