Provider Demographics
NPI:1689865586
Name:ABBEVILLE FAMILY HEALTHCARE
Entity Type:Organization
Organization Name:ABBEVILLE FAMILY HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:DURHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:864-366-7777
Mailing Address - Street 1:102 ELLIS AVE
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29620-2114
Mailing Address - Country:US
Mailing Address - Phone:864-366-7777
Mailing Address - Fax:864-366-7778
Practice Address - Street 1:102 ELLIS AVE
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29620-2114
Practice Address - Country:US
Practice Address - Phone:864-366-7777
Practice Address - Fax:864-366-7778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1154111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC=========OtherTAX ID NUMBER