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NPI Code Detail

MEDICARE: DR. BARNEY VAN DURHAM II D.C.

MEDICARE: DR. BARNEY VAN DURHAM II D.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractorCH9939FL

General Provider Information

NPI Number : 1215258983
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BARNEY VAN DURHAM II D.C.
Provider Business Mailing Address
First Line : 1413 KINGSLEY AVE
Second Line :
City : ORANGE PARK
State : FL
Zip : 32073-4527
Country : US
Telephone Number : 904-264-3966
Fax Number : 904-278-7171
Provider Business Practice Location Address
First Line : 1413 KINGSLEY AVE
Second Line :
City : ORANGE PARK
State : FL
Zip : 32073-4527
Country : US
Telephone Number : 904-264-3966
Fax Number : 904-278-7171
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2010
Last Update Date : 06/17/2010

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