Provider Demographics
NPI:1487841615
Name:DUFFY CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:DUFFY CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:DUFFY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-733-9330
Mailing Address - Street 1:811 N LYNNDALE DR STE 1B
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-3085
Mailing Address - Country:US
Mailing Address - Phone:920-733-9330
Mailing Address - Fax:920-733-7220
Practice Address - Street 1:811 N LYNNDALE DR STE 1B
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-3085
Practice Address - Country:US
Practice Address - Phone:920-733-9330
Practice Address - Fax:920-733-7220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3260251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38892200Medicaid