Provider Demographics
NPI:1598971582
Name:DUFF, JOHN MATTHEW (DC)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:MATTHEW
Last Name:DUFF
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:PO BOX 45
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85380-0045
Mailing Address - Country:US
Mailing Address - Phone:623-776-1555
Mailing Address - Fax:623-845-0667
Practice Address - Street 1:8466 W PEORIA AVE
Practice Address - Street 2:#11
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-6548
Practice Address - Country:US
Practice Address - Phone:623-776-1555
Practice Address - Fax:623-845-0667
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7297111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0937530OtherBLUE CROSS BLUE SHIELD
AZAZ0937530OtherBLUE CROSS BLUE SHIELD