Provider Demographics
NPI:1649262056
Name:DUBOIS, ROBERT F (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:F
Last Name:DUBOIS
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 1:375 TUCKIE RD STE B
Mailing Address - Street 2:
Mailing Address - City:NORTH WINDHAM
Mailing Address - State:CT
Mailing Address - Zip Code:06256-1345
Mailing Address - Country:US
Mailing Address - Phone:860-456-1046
Mailing Address - Fax:860-456-5673
Practice Address - Street 1:375 B TUCKIE RD
Practice Address - Street 2:
Practice Address - City:NORTH WINDHAM
Practice Address - State:CT
Practice Address - Zip Code:06256-1345
Practice Address - Country:US
Practice Address - Phone:860-456-1046
Practice Address - Fax:860-456-5673
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000591111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT350000495Medicare ID - Type Unspecified