Provider Demographics
NPI:1891115069
Name:DURRUM CHIROPRACTIC CLINIC LLC
Entity Type:Organization
Organization Name:DURRUM CHIROPRACTIC CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR./OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:DURRUM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:903-572-1128
Mailing Address - Street 1:1011 N JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455-3261
Mailing Address - Country:US
Mailing Address - Phone:903-572-1128
Mailing Address - Fax:903-572-1138
Practice Address - Street 1:1011 N JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-3261
Practice Address - Country:US
Practice Address - Phone:903-572-1128
Practice Address - Fax:903-572-1138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-25
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8436111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty