MEDICARE: DR. ROBERT F DUBOIS DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	000591	CT

General Provider Information

NPI Number	:	1649262056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT F DUBOIS DC

Provider Business Mailing Address
First Line	:	375 TUCKIE RD STE B
Second Line	:
City	:	NORTH WINDHAM
State	:	CT
Zip	:	06256-1345
Country	:	US
Telephone Number	:	860-456-1046
Fax Number	:	860-456-5673

Provider Business Practice Location Address
First Line	:	375 B TUCKIE RD
Second Line	:
City	:	NORTH WINDHAM
State	:	CT
Zip	:	06256-1345
Country	:	US
Telephone Number	:	860-456-1046
Fax Number	:	860-456-5673

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	05/05/2008

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