Provider Demographics
NPI:1851465322
Name:DURBIN, SCOTT F (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:F
Last Name:DURBIN
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 1:136 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEED
Mailing Address - State:CA
Mailing Address - Zip Code:96094-2574
Mailing Address - Country:US
Mailing Address - Phone:530-938-3045
Mailing Address - Fax:530-938-3045
Practice Address - Street 1:136 MAIN ST
Practice Address - Street 2:
Practice Address - City:WEED
Practice Address - State:CA
Practice Address - Zip Code:96094-2574
Practice Address - Country:US
Practice Address - Phone:530-938-3045
Practice Address - Fax:530-938-3045
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19106111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA68-0218078OtherTAX ID NUMBER
CA68-0218078OtherTAX ID NUMBER