Individual
DR. DERRICK T DUBE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
8016 STATE LINE RD, STE 100, PRAIRIE VILLAGE, KS 66208-3721
(913) 826-6837
(913) 341-4301
Mailing address
2470 S VAL VISTA DR, STE 104, GILBERT, AZ 85295-1693
(602) 592-4193
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
8720
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01-05796
STATE LICENSE NUMBER
KS
01
—
81-2039071
FEDERAL TAX IDENTIFICATION NUMBER
—
01
—
8247108
EIN
KS
Enumeration date
05/09/2016
Last updated
07/24/2018
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