Provider Demographics
NPI:1154515955
Name:DUBOIS, GORDON A (DC)
Entity type:Individual
Prefix:
First Name:GORDON
Middle Name:A
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:PO BOX 750400
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70175-0400
Mailing Address - Country:US
Mailing Address - Phone:504-861-7167
Mailing Address - Fax:
Practice Address - Street 1:7611 MAPLE ST
Practice Address - Street 2:SUITE 101C
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118-5068
Practice Address - Country:US
Practice Address - Phone:504-861-7167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1007111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5T676CG26Medicare UPIN