1073681607 NPI number — DUDDY CHIROPRACTIC

Table of content: (NPI 1073681607)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073681607 NPI number — DUDDY CHIROPRACTIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DUDDY CHIROPRACTIC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

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

NPI Number Information

NPI Number:
1073681607
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 S 22ND ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EASTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18042-3811
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-253-5332
Provider Business Mailing Address Fax Number:
610-253-5975

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 S 22ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EASTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18042-3811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-253-5332
Provider Business Practice Location Address Fax Number:
610-253-5975
Provider Enumeration Date:
12/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DUDDY
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
THOMAS
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
610-253-5332

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC004349L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: DC007108L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 110363 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 607153 . This is a "ACN GROUP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 901579 . This is a "MEDICARE PTAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0282107000 . This is a "AMERIHEALTH IBX" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: DU712460 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 02870600 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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