=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205021409
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DURANT CHIROPRACTIC CLINIC INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/11/2007
-----------------------------------------------------
Last Update Date | 09/11/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1435 DUNN AVE
-----------------------------------------------------
City | DAYTONA BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32114-1437
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-255-9522
-----------------------------------------------------
Fax | 386-255-9082
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1435 DUNN AVE
-----------------------------------------------------
City | DAYTONA BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32114-1437
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-255-9522
-----------------------------------------------------
Fax | 386-255-9082
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MICHAEL CHARLES DURANT
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 386-255-9522
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH0006099
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------