Provider Demographics
NPI:1609850924
Name:DURHAM, ROBERT M (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:M
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 1:107 RIVER DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTON
Mailing Address - State:SC
Mailing Address - Zip Code:29697-2018
Mailing Address - Country:US
Mailing Address - Phone:864-847-1849
Mailing Address - Fax:
Practice Address - Street 1:900 GREENVILLE DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:SC
Practice Address - Zip Code:29697-1130
Practice Address - Country:US
Practice Address - Phone:864-847-1818
Practice Address - Fax:864-847-5706
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1600111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCU29360Medicare UPIN
SCU293607564Medicare ID - Type Unspecified