Provider Demographics
NPI:1114740917
Name:DUBA, MAE (DC)
Entity type:Individual
Prefix:
First Name:MAE
Middle Name:
Last Name:DUBA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 FLORENCE AVE APT 212
Mailing Address - Street 2:
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-6310
Mailing Address - Country:US
Mailing Address - Phone:605-680-9751
Mailing Address - Fax:
Practice Address - Street 1:603 3RD ST SE STE A
Practice Address - Street 2:
Practice Address - City:KASSON
Practice Address - State:MN
Practice Address - Zip Code:55944-2943
Practice Address - Country:US
Practice Address - Phone:507-634-7288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-01
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7277111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor