Provider Demographics
NPI:1710949722
Name:DURHAM, JOEL W (DC)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:W
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 1:25 CORPORATE BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-2314
Mailing Address - Country:US
Mailing Address - Phone:731-664-2929
Mailing Address - Fax:731-664-7555
Practice Address - Street 1:25 CORPORATE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2314
Practice Address - Country:US
Practice Address - Phone:731-664-2929
Practice Address - Fax:731-664-7555
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC-831111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1719192OtherCIGNA
TN3154438OtherBLUE CROSS
TN350050083OtherRAILROAD MEDICARE
TN00001997769-02OtherUNITED HEALTHCARE OF TENN
TN5744028OtherAETNA
TN5744028OtherAETNA
TN350050083OtherRAILROAD MEDICARE