1609170059 NPI number — DR. JENNY LYNN DUBISAR DC, FICPA

Table of content: DR. JENNY LYNN DUBISAR DC, FICPA (NPI 1609170059)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609170059 NPI number — DR. JENNY LYNN DUBISAR DC, FICPA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUBISAR
Provider First Name:
JENNY
Provider Middle Name:
LYNN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC, FICPA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BROST
Provider Other First Name:
JENNY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1609170059
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2671 E AUGUSTA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHANDLER
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85249-4878
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-200-6679
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2671 E AUGUSTA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHANDLER
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85249-4878
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-200-6679
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/28/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  7731 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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