Provider Demographics
NPI:1639458219
Name:DIDURO CHIROPRACTIC AND ASSOCIATES PC
Entity Type:Organization
Organization Name:DIDURO CHIROPRACTIC AND ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:O
Authorized Official - Last Name:DIDURO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:5602-663-4808
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:877-222-3641
Practice Address - Street 1:1300 N 12TH ST
Practice Address - Street 2:310
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2848
Practice Address - Country:US
Practice Address - Phone:602-663-4808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-12
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7757111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Multi-Specialty