Provider Demographics
NPI:1639130685
Name:DUDDY, SCOTT THOMAS (DC)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:THOMAS
Last Name:DUDDY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1700 NORTHAMPTON ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042-3144
Mailing Address - Country:US
Mailing Address - Phone:610-253-5332
Mailing Address - Fax:610-253-5795
Practice Address - Street 1:1700 NORTHAMPTON ST
Practice Address - Street 2:SUITE D
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-3144
Practice Address - Country:US
Practice Address - Phone:610-253-5332
Practice Address - Fax:610-253-5795
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004349L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1032446OtherASHN
PA607153OtherACN
PA12047382OtherMULTIPLAN
PA4364644OtherCIGNA
PA926028OtherUNITED HEALTHCARE
PA02870600OtherCAPITAL BLUE CROSS
PA607153OtherGREAT WEST HEALTHCARE
PA0530098000OtherAMERIHEALTH / KEYSTONE
PA5441323OtherAETNA
PADU695076OtherHIGHMARK BC/BS
PAP907568OtherOXFORD HEALTH PLAN
PA16170OtherOPERATING ENG LOCAL 825
PAP907568OtherTRIAD HEALTHCARE
PA4364644OtherCIGNA
PAU61066Medicare UPIN