Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 06728 | IA |
N | 111N00000X | Chiropractor | 11048 | NY |
Y | 111NN0400X | Neurology | 7757 | AZ |
NPI | 1548220841 |
---|---|
Provider Name | Dr. Joseph O Diduro |
First Address | Maricopa, AZ 85138-2445 |
Second Address | Maricopa, AZ 85238-2445 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2006 |
Last Update Date | 06/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T26104 | (02) | IA |