Provider Demographics
NPI:1386647774
Name:DURHAM, RAYMOND T (DC)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:T
Last Name:DURHAM
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 1:400 DEL WEBB BLVD
Mailing Address - Street 2:STE 103B
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-4484
Mailing Address - Country:US
Mailing Address - Phone:512-864-2880
Mailing Address - Fax:512-864-2881
Practice Address - Street 1:400 DEL WEBB BLVD
Practice Address - Street 2:STE 103B
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-4484
Practice Address - Country:US
Practice Address - Phone:512-864-2880
Practice Address - Fax:512-864-2881
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7228111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0200XChiropractic ProvidersChiropractorRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX667532OtherACN GROUP
TX605681OtherBLUECROSS BLUESHIELD TX
TX8265913OtherBLUE LINK
TXDC7228OtherCHIROPRACTIC LICENSE
TX8265913OtherBLUE LINK
TX667532OtherACN GROUP