Provider Demographics
NPI:1245262625
Name:DURHAM, GEORGE A (DC)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:A
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 1:5443 EVERHART RD STE C
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-4888
Mailing Address - Country:US
Mailing Address - Phone:361-852-2211
Mailing Address - Fax:361-852-2633
Practice Address - Street 1:5443 EVERHART RD STE C
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4888
Practice Address - Country:US
Practice Address - Phone:361-852-2211
Practice Address - Fax:361-852-2633
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7282111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX276768OtherMEDICARE GROUP
TXU67224Medicare UPIN