Provider Demographics
NPI:1710050190
Name:DUFFY, JEAN MARIE (D C)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:MARIE
Last Name:DUFFY
Suffix:
Gender:F
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 E WILBUR RD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-5572
Mailing Address - Country:US
Mailing Address - Phone:805-495-2453
Mailing Address - Fax:805-495-4532
Practice Address - Street 1:101 HODENCAMP RD STE 214
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-5835
Practice Address - Country:US
Practice Address - Phone:805-495-2453
Practice Address - Fax:805-495-4532
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC16348111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor