Provider Demographics
NPI:1528133543
Name:JOHN E. DUBOIS III D C
Entity type:Organization
Organization Name:JOHN E. DUBOIS III D C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-375-9721
Mailing Address - Street 1:9 BEAVER DR
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-2401
Mailing Address - Country:US
Mailing Address - Phone:814-375-9721
Mailing Address - Fax:814-375-9721
Practice Address - Street 1:9 BEAVER DR
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-2401
Practice Address - Country:US
Practice Address - Phone:814-375-9721
Practice Address - Fax:814-375-9721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002914L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009923600001Medicaid
PA0009923600001Medicaid
PAT27044Medicare UPIN