Provider Demographics
NPI:1548220841
Name:DIDURO, JOSEPH O (DC DABCN MS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:O
Last Name:DIDURO
Suffix:
Gender:M
Credentials:DC DABCN MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20225 N RYANS TRL
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138-2445
Mailing Address - Country:US
Mailing Address - Phone:480-789-0953
Mailing Address - Fax:
Practice Address - Street 1:20225 N RYANS TRL
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85238-2445
Practice Address - Country:US
Practice Address - Phone:480-789-0953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06728111N00000X
NY11048111N00000X
AZ7757111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAT26104Medicare UPIN