Provider Demographics
NPI:1700475399
Name:DUFFIELD, SAMANTHA LAUREN (DC)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:LAUREN
Last Name:DUFFIELD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 31ST AVE E APT 4
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-8392
Mailing Address - Country:US
Mailing Address - Phone:763-587-3449
Mailing Address - Fax:
Practice Address - Street 1:395 31ST AVE E APT 4
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-8392
Practice Address - Country:US
Practice Address - Phone:763-587-3449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1136111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty