Healthcare Provider Details

I. General information

NPI: 1447582150
Provider Name (Legal Business Name): BRIAN D DUBY DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2010
Last Update Date: 10/13/2023
Certification Date: 10/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 SE MADISON ST STE 100A
PORTLAND OR
97214-3600
US

IV. Provider business mailing address

1125 SE MADISON ST STE 100A
PORTLAND OR
97214-3600
US

V. Phone/Fax

Practice location:
  • Phone: 503-935-9488
  • Fax: 971-260-4989
Mailing address:
  • Phone: 503-935-9488
  • Fax: 971-260-4989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number3235
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number3235
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License Number3235
License Number StateOR
# 4
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3235
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: