Provider Demographics
NPI:1649280728
Name:DUFOUR, PETER JOSEPH IV (DC, FIAMA)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:JOSEPH
Last Name:DUFOUR
Suffix:IV
Gender:M
Credentials:DC, FIAMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2390 N ALMA SCHOOL RD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-2416
Mailing Address - Country:US
Mailing Address - Phone:480-839-2225
Mailing Address - Fax:480-917-0518
Practice Address - Street 1:2390 N ALMA SCHOOL RD
Practice Address - Street 2:SUITE 115
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-2416
Practice Address - Country:US
Practice Address - Phone:480-839-2225
Practice Address - Fax:480-917-0518
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5572111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0932760OtherBLUE CROSS BLUE SHIELD
AZ65469Medicare ID - Type Unspecified
AZ0932760OtherBLUE CROSS BLUE SHIELD