Provider Demographics
NPI:1487736914
Name:DUDDY, MATTHEW SHAWN (DC)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:SHAWN
Last Name:DUDDY
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 1:417 PENNSYLVANIA AVE
Mailing Address - Street 2:PO BOX 217
Mailing Address - City:AVONDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19311-0297
Mailing Address - Country:US
Mailing Address - Phone:610-268-8122
Mailing Address - Fax:610-268-3103
Practice Address - Street 1:417 PENNSYLVANIA AVE.
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:PA
Practice Address - Zip Code:19311-0297
Practice Address - Country:US
Practice Address - Phone:610-268-8122
Practice Address - Fax:610-268-3103
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004583L111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation