Provider Demographics
NPI:1043611890
Name:DURBIN, SHAWN (DC)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:DURBIN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 W LOUCKS AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61604-2604
Mailing Address - Country:US
Mailing Address - Phone:309-688-4484
Mailing Address - Fax:309-688-4485
Practice Address - Street 1:1200 W LOUCKS AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61604-2604
Practice Address - Country:US
Practice Address - Phone:309-688-4484
Practice Address - Fax:309-688-4485
Is Sole Proprietor?:No
Enumeration Date:2014-09-11
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.008861111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor