Healthcare Provider Details

I. General information

NPI: 1487736914
Provider Name (Legal Business Name): MATTHEW SHAWN DUDDY D.C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 PENNSYLVANIA AVE.
AVONDALE PA
19311-0297
US

IV. Provider business mailing address

417 PENNSYLVANIA AVE
AVONDALE PA
19311-1120
US

V. Phone/Fax

Practice location:
  • Phone: 610-268-8122
  • Fax: 610-268-3103
Mailing address:
  • Phone: 610-268-8122
  • Fax: 610-268-3103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC004583L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: