Provider Demographics
NPI:1770614257
Name:DUQUE, FREDY ALEXANDER (DC)
Entity type:Individual
Prefix:DR
First Name:FREDY
Middle Name:ALEXANDER
Last Name:DUQUE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 TUNXIS HILL RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-4442
Mailing Address - Country:US
Mailing Address - Phone:203-333-7788
Mailing Address - Fax:203-366-7566
Practice Address - Street 1:527 TUNXIS HILL RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-4442
Practice Address - Country:US
Practice Address - Phone:203-333-7788
Practice Address - Fax:203-366-7566
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001538111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic