Provider Demographics
NPI:1306021720
Name:DR PETER J DUFOUR IV DC FIAMA PA
Entity Type:Organization
Organization Name:DR PETER J DUFOUR IV DC FIAMA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:DUFOUR
Authorized Official - Suffix:IV
Authorized Official - Credentials:DC, FIAMA
Authorized Official - Phone:480-839-2225
Mailing Address - Street 1:2390 N ALMA SCHOOL RD
Mailing Address - Street 2:115
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-2416
Mailing Address - Country:US
Mailing Address - Phone:480-839-2225
Mailing Address - Fax:480-917-0518
Practice Address - Street 1:2390 N ALMA SCHOOL RD
Practice Address - Street 2:115
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-2416
Practice Address - Country:US
Practice Address - Phone:480-839-2225
Practice Address - Fax:480-917-0518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5572111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty