Provider Demographics
NPI:1235169939
Name:DADUFALZA, MARY (DC)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:DADUFALZA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 WASHINGTON DR STE F
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-2528
Mailing Address - Country:US
Mailing Address - Phone:817-459-0220
Mailing Address - Fax:817-459-0207
Practice Address - Street 1:805 WASHINGTON DR STE F
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-2528
Practice Address - Country:US
Practice Address - Phone:817-459-0220
Practice Address - Fax:817-704-0108
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9398111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor