Provider Demographics
NPI:1164564803
Name:DUKE, DARRELL DUANE (DC)
Entity Type:Individual
Prefix:MR
First Name:DARRELL
Middle Name:DUANE
Last Name:DUKE
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:POST OFFICE BOX 756
Mailing Address - Street 2:400 EAST FIRST STREET STE #104
Mailing Address - City:DUMAS
Mailing Address - State:TX
Mailing Address - Zip Code:79029
Mailing Address - Country:US
Mailing Address - Phone:806-934-2476
Mailing Address - Fax:806-934-2476
Practice Address - Street 1:400 EAST FIRST STREET
Practice Address - Street 2:SUITE #104
Practice Address - City:DUMAS
Practice Address - State:TX
Practice Address - Zip Code:79029
Practice Address - Country:US
Practice Address - Phone:806-934-2476
Practice Address - Fax:806-934-2476
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2776111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC2776Medicare UPIN
TX601087Medicare ID - Type Unspecified