Provider Demographics
NPI:1083682348
Name:DUFFY, SEAN C (DC)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:C
Last Name:DUFFY
Suffix:
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 1:811 N LYNNDALE DR
Mailing Address - Street 2:STE1B
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-3085
Mailing Address - Country:US
Mailing Address - Phone:920-733-9330
Mailing Address - Fax:920-733-7220
Practice Address - Street 1:811 N LYNNDALE DR
Practice Address - Street 2:STE 1B
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-3085
Practice Address - Country:US
Practice Address - Phone:920-733-9330
Practice Address - Fax:920-733-7220
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3260111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38892200Medicaid
WI38892200Medicaid
WI000175845Medicare ID - Type UnspecifiedMEDICARE SEQUENCE INDIVID
WI000075845Medicare ID - Type UnspecifiedMEDICARE GROUP #