Healthcare Provider Details

I. General information

NPI: 1508867359
Provider Name (Legal Business Name): STEPHEN MICHAEL DUBUC D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2293 SAUNDERS SETTLEMENT RD
SANBORN NY
14132-9336
US

IV. Provider business mailing address

2293 SAUNDERS SETTLEMENT RD
SANBORN NY
14132-9336
US

V. Phone/Fax

Practice location:
  • Phone: 716-297-9123
  • Fax: 716-297-6717
Mailing address:
  • Phone: 716-297-9123
  • Fax: 716-297-6717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX007495
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: