Individual provider Active NPI

Sean C Duffy, D.C.

  • Chiropractor
  • Appleton, WI
National Provider Identifier
1083682348
Registry record updated Nov 16, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
3260 Issued in WI
Practice address
811 N Lynndale Dr
Ste 1B
Appleton, WI 54914-3085
Phone
(920) 733-9330
Fax
(920) 733-7220
NPI assigned
Mar 10, 2006
Last updated
Nov 16, 2010By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 16, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 3260 WI Primary

Addresses

Primary practice location

811 N Lynndale Dr
Ste 1B
Appleton, WI 54914-3085

Mailing address

811 N Lynndale Dr
Ste1B
Appleton, WI 54914-3085
Phone (920) 733-9330

Other identifiers 1

IdentifierTypeStateIssuer
38892200MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040324000716 WI Practitioner - Chiropractic 9931098977 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Palmer College Chiropractic - West Sunnyvale, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Duffy Chiropractic IncGroup PAC ID 2163311184, 3 clinicians

Practice addresses (Care Compare)

811 N Lynndale Dr
Suite 1B
Appleton, WI 54914-3085
Phone (920) 733-9330

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3260WIMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Duffy Chiropractic Inc. Chiropractor CurrentSince Jan 1, 2003 Accepting new patients

Locations

811 N Lynndale Dr
Ste 1B
Appleton, WI 54914
Phone (920) 733-9330

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1141948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1289865600000",
    "number": "1083682348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "811 N LYNNDALE DR",
            "address_2": "STE1B",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549143085",
            "telephone_number": "920-733-9330",
            "fax_number": "920-733-7220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "811 N LYNNDALE DR",
            "address_2": "STE 1B",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549143085",
            "telephone_number": "920-733-9330",
            "fax_number": "920-733-7220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUFFY",
        "first_name": "SEAN",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-10",
        "last_updated": "2010-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "3260",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38892200",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Appleton, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.