Provider Demographics
NPI:1407903628
Name:DUFORE, NEIL R (DC)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:R
Last Name:DUFORE
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 1:1726 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:IRONTON
Mailing Address - State:OH
Mailing Address - Zip Code:45638-2284
Mailing Address - Country:US
Mailing Address - Phone:740-532-1016
Mailing Address - Fax:740-532-4651
Practice Address - Street 1:1726 S 3RD ST
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:OH
Practice Address - Zip Code:45638-2284
Practice Address - Country:US
Practice Address - Phone:740-532-1016
Practice Address - Fax:740-532-4651
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH 595111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH31-11832834001OtherBLUE CROSS OF OHIO
OH311183283-00OtherOHIO WORKERS COMPENSATION
OH792350184OtherRAILROAD MEDICARE
OH31-11832834001OtherBLUE CROSS OF OHIO
OH792350184OtherRAILROAD MEDICARE