Provider Demographics
NPI:1174521231
Name:DUBRUL, SCOTT ALAN I (DC)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ALAN
Last Name:DUBRUL
Suffix:I
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1422 MONTEREY ST
Mailing Address - Street 2:A201
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-2944
Mailing Address - Country:US
Mailing Address - Phone:805-781-9155
Mailing Address - Fax:805-781-0141
Practice Address - Street 1:1422 MONTEREY ST
Practice Address - Street 2:A201
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2944
Practice Address - Country:US
Practice Address - Phone:805-781-9155
Practice Address - Fax:805-781-0141
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22650111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor