Provider Demographics
NPI:1316008022
Name:DUDDY, JARED M (DC)
Entity Type:Individual
Prefix:DR
First Name:JARED
Middle Name:M
Last Name:DUDDY
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 1:645 E BUTLER AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-5300
Mailing Address - Country:US
Mailing Address - Phone:215-230-1999
Mailing Address - Fax:215-230-0363
Practice Address - Street 1:645 E BUTLER AVE
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:PA
Practice Address - Zip Code:18901-5300
Practice Address - Country:US
Practice Address - Phone:215-230-1999
Practice Address - Fax:215-230-0363
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007108L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA12047381OtherMULTI PLAN
PA5020659OtherAETNA
PA0452630000OtherIBC AHA KEYSTONE
PAP3244214OtherOXFORD TRIAD
PAGEISSINGER HEALTHOther101388
PA4501062OtherGHI
PA1032227OtherASHN
PA5687279OtherFIRST HEALTH CCN
PA79152OtherOPERATING ENGINEERS
PA5864360OtherCBC
PA607153OtherGREAT WEST
PA2047440OtherUNTIED HEALTHCARE
PA5020659OtherAETNA
PA0452630000OtherIBC AHA KEYSTONE