Provider Demographics
NPI:1396797197
Name:SCARBOROUGH, DUANE D (DC)
Entity type:Individual
Prefix:MR
First Name:DUANE
Middle Name:D
Last Name:SCARBOROUGH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:DUANE
Other - Middle Name:D
Other - Last Name:SCARBOROUGHCHIROPR&WELLNESS SERVICE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4831 BATAVIA ELBA TOWNLINE RD
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-9784
Mailing Address - Country:US
Mailing Address - Phone:585-343-4427
Mailing Address - Fax:585-343-8158
Practice Address - Street 1:4931 BATAVIA ELBA TOWNLINE RD
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-9784
Practice Address - Country:US
Practice Address - Phone:585-343-4427
Practice Address - Fax:585-343-8158
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0022011111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY076791Medicare ID - Type Unspecified