Provider Demographics
NPI:1174031728
Name:DURKIN PHYSICAL MEDICINE
Entity Type:Organization
Organization Name:DURKIN PHYSICAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:DURKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:773-573-0895
Mailing Address - Street 1:4340 MARYLAND AVE APT 9C
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-2700
Mailing Address - Country:US
Mailing Address - Phone:773-573-0895
Mailing Address - Fax:
Practice Address - Street 1:1099 MILWAUKEE ST STE 240
Practice Address - Street 2:
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-7360
Practice Address - Country:US
Practice Address - Phone:314-822-1502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-17
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018000924111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty