Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 001538 | CT |
NPI | 1770614257 |
---|---|
Provider Name | Dr. Fredy Alexander Duque |
First Address | Fairfield, CT 06825-4442 |
Second Address | Fairfield, CT 06825-4442 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2007 |
Last Update Date | 08/07/2007 |