Provider Demographics
NPI:1205045606
Name:DIFFENDERFER ENTERPRISES INC
Entity Type:Organization
Organization Name:DIFFENDERFER ENTERPRISES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:E
Authorized Official - Last Name:DIFFENDERFER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:740-474-9777
Mailing Address - Street 1:1430 N COURT ST
Mailing Address - Street 2:
Mailing Address - City:CIRCLEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43113-1005
Mailing Address - Country:US
Mailing Address - Phone:740-474-9777
Mailing Address - Fax:740-474-6225
Practice Address - Street 1:1430 N COURT ST
Practice Address - Street 2:
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113-1005
Practice Address - Country:US
Practice Address - Phone:740-474-9777
Practice Address - Fax:740-474-6225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC1077111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH168369204002OtherMEDICAL MUTUAL
OH000000120712OtherGROUP ANTHEM
OH1205045606Medicare PIN