Provider Demographics
NPI:1497190052
Name:DUFFER, ALICE HART (DC)
Entity Type:Individual
Prefix:DR
First Name:ALICE
Middle Name:HART
Last Name:DUFFER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:ALYSE
Other - Middle Name:HART
Other - Last Name:DUFFER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:14210 HIGHWAY 3 STE B
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-1603
Mailing Address - Country:US
Mailing Address - Phone:832-240-4319
Mailing Address - Fax:832-240-4263
Practice Address - Street 1:14210 HIGHWAY 3 STE B
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-1603
Practice Address - Country:US
Practice Address - Phone:832-240-4319
Practice Address - Fax:832-240-4263
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-08
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12244111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor