=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700475399
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SAMANTHA LAUREN DUFFIELD DC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/18/2021
-----------------------------------------------------
Last Update Date | 01/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1308 12TH AVE S
-----------------------------------------------------
City | GREAT FALLS
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59405-4607
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-453-8885
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1308 12TH AVE S
-----------------------------------------------------
City | GREAT FALLS
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59405-4607
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-587-3449
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 8032
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------