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General NPI Number Information
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NPI Number | 1568498970
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Entity Type | Organization
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Legal Business Name | DE DUBOVAY CHIROPRACTIC, INC.
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Dates
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Enumeration Date | 06/25/2006
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Last Update Date | 08/27/2018
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Provider Practice Location Address
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Address Line | 14340 BOLSA CHICA RD STE G
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City | WESTMINSTER
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State | CA
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Zip | 92683
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Country | US
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Telephone | 562-795-6680
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Fax | 562-799-9575
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Provider Business Mailing Address
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Address Line | 14340 BOLSA CHICA RD STE G
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City | WESTMINSTER
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State | CA
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Zip | 92683-4868
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Country | US
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Telephone | 562-795-6680
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Fax | 562-799-9575
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK DE DUBOVAY
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Credential | D.C.
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Telephone | 562-795-6680
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC16862
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC17394
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License Number State | CA
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