Provider Demographics
NPI:1346631801
Name:DURBIN, CHELSEA LEE (BS, DC)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:LEE
Last Name:DURBIN
Suffix:
Gender:F
Credentials:BS, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 997
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-0997
Mailing Address - Country:US
Mailing Address - Phone:618-692-6700
Mailing Address - Fax:618-692-6711
Practice Address - Street 1:8 GINGER CREEK PKWY
Practice Address - Street 2:
Practice Address - City:GLEN CARBON
Practice Address - State:IL
Practice Address - Zip Code:62034-3502
Practice Address - Country:US
Practice Address - Phone:618-692-6700
Practice Address - Fax:618-692-6711
Is Sole Proprietor?:No
Enumeration Date:2015-02-05
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.012734111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor