Provider Demographics
NPI:1609099555
Name:DURRUM, COURTNEY M (DC)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:M
Last Name:DURRUM
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 1:1318 S JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455-5355
Mailing Address - Country:US
Mailing Address - Phone:903-572-1128
Mailing Address - Fax:903-572-1138
Practice Address - Street 1:1318 S JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-5355
Practice Address - Country:US
Practice Address - Phone:903-572-1128
Practice Address - Fax:903-572-1138
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8436111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0200XChiropractic ProvidersChiropractorRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU80009Medicare UPIN
TX393452ZMPVMedicare PIN
TX609368Medicare ID - Type Unspecified