Healthcare Provider Details

I. General information

NPI: 1770614257
Provider Name (Legal Business Name): FREDY ALEXANDER DUQUE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 TUNXIS HILL RD
FAIRFIELD CT
06825-4442
US

IV. Provider business mailing address

527 TUNXIS HILL RD
FAIRFIELD CT
06825-4442
US

V. Phone/Fax

Practice location:
  • Phone: 203-333-7788
  • Fax: 203-366-7566
Mailing address:
  • Phone: 203-333-7788
  • Fax: 203-366-7566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number001538
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: