=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396046496
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAROLYN DURHAM INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/06/2010
-----------------------------------------------------
Last Update Date | 11/06/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 611 N NEVADA AVE SUITE3
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80903-1099
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-229-9235
-----------------------------------------------------
Fax | 719-447-9262
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 611 N NEVADA AVE SUITE3
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80903-1099
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-229-9235
-----------------------------------------------------
Fax | 719-447-9262
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWER, PRESIDENT
-----------------------------------------------------
Name | MRS. CAROLYN DURHAM
-----------------------------------------------------
Credential | RMT
-----------------------------------------------------
Telephone | 719-229-9238
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 1335
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------