Provider Demographics
NPI:1356842595
Name:DURHAM, MOLLY CAITLIN (DC)
Entity Type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:CAITLIN
Last Name:DURHAM
Suffix:
Gender:F
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:PO BOX 12559
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-2559
Mailing Address - Country:US
Mailing Address - Phone:910-238-2330
Mailing Address - Fax:910-238-2320
Practice Address - Street 1:445 WESTERN BLVD STE O
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6852
Practice Address - Country:US
Practice Address - Phone:910-238-2330
Practice Address - Fax:910-238-2320
Is Sole Proprietor?:No
Enumeration Date:2018-02-22
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4899111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor