Healthcare Provider Details

I. General information

NPI: 1710949722
Provider Name (Legal Business Name): JOEL W DURHAM DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 08/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 CORPORATE BLVD
JACKSON TN
38305-2314
US

IV. Provider business mailing address

25 CORPORATE BLVD
JACKSON TN
38305-2314
US

V. Phone/Fax

Practice location:
  • Phone: 731-664-2929
  • Fax: 731-664-7555
Mailing address:
  • Phone: 731-664-2929
  • Fax: 731-664-7555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDC-831
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: