Provider Demographics
NPI:1740337419
Name:DURBIN, MISTY MICHELLE (DC)
Entity type:Individual
Prefix:DR
First Name:MISTY
Middle Name:MICHELLE
Last Name:DURBIN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5022 HOLLY RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-4761
Mailing Address - Country:US
Mailing Address - Phone:361-991-8887
Mailing Address - Fax:361-991-8889
Practice Address - Street 1:5022 HOLLY RD
Practice Address - Street 2:SUITE 104
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4761
Practice Address - Country:US
Practice Address - Phone:361-991-8887
Practice Address - Fax:361-991-8889
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC10083111N00000X
TX10083111NP0017X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX317335301Medicaid
TX258036YKTQMedicare PIN
TXV07668Medicare UPIN