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General NPI Number Information
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NPI Number | 1609970151
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Entity Type | Individual
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Provider Name | DAVID GRANT DURHAM D.C.
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Gender | Male
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Dates
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Enumeration Date | 09/12/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2175 ROUTE 29 NORTH
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City | EDINBURG
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State | IL
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Zip | 62531
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Country | US
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Telephone | 217-623-4505
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Fax | 217-623-4506
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Provider Business Mailing Address
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Address Line | 2175 ROUTE 29 NORTH P.O. BOX 303
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City | EDINBURG
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State | IL
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Zip | 62531
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Country | US
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Telephone | 217-623-4505
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Fax | 217-623-4506
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 038-010457
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License Number State | IA
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