Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | X009932-1 | NY |
NPI | 1073604450 |
---|---|
Provider Name | Dr. Beth J Dubois |
First Address | Oswego, NY 13126-2120 |
Second Address | Oswego, NY 13126-2120 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 24/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
57917 | (02) | NY |
C09932-7B | WORKERS COMPENSATION (01) | NY |
X009932-1 | LIC NUMBER (01) | NY |