Provider Demographics
NPI:1609170059
Name:DUBISAR, JENNY LYNN (DC, FICPA)
Entity type:Individual
Prefix:DR
First Name:JENNY
Middle Name:LYNN
Last Name:DUBISAR
Suffix:
Gender:F
Credentials:DC, FICPA
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:
Other - Last Name:BROST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2671 E AUGUSTA AVE
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-4878
Mailing Address - Country:US
Mailing Address - Phone:480-200-6679
Mailing Address - Fax:
Practice Address - Street 1:2671 E AUGUSTA AVE
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249-4878
Practice Address - Country:US
Practice Address - Phone:480-200-6679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-28
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7731111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor