Provider Demographics
NPI:1457056194
Name:DUBBS CHIROPRACTIC OFFICE PLLC
Entity Type:Organization
Organization Name:DUBBS CHIROPRACTIC OFFICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:E
Authorized Official - Last Name:KHAZNEHKATBI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:865-850-2198
Mailing Address - Street 1:122 NEW ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043-5623
Mailing Address - Country:US
Mailing Address - Phone:586-468-5381
Mailing Address - Fax:
Practice Address - Street 1:122 NEW ST
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-5623
Practice Address - Country:US
Practice Address - Phone:586-468-5381
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E01639OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
1982602967OtherNPI