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NPI Code Detail

MEDICARE: DR. RAYMOND T. DURHAM D.C.

MEDICARE:  DR. RAYMOND T. DURHAM  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
1111NR0200XRadiology Chiropractor7228TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1667532OTHERTXACN GROUP
2605681OTHERTXBLUECROSS BLUESHIELD TX
38265913OTHERTXBLUE LINK
4DC7228OTHERTXCHIROPRACTIC LICENSE

General Provider Information

NPI Number : 1386647774
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RAYMOND T. DURHAM D.C.
Provider Business Mailing Address
First Line : 400 DEL WEBB BLVD
Second Line : STE 103B
City : GEORGETOWN
State : TX
Zip : 78628-4484
Country : US
Telephone Number : 512-864-2880
Fax Number : 512-864-2881
Provider Business Practice Location Address
First Line : 400 DEL WEBB BLVD
Second Line : STE 103B
City : GEORGETOWN
State : TX
Zip : 78628-4484
Country : US
Telephone Number : 512-864-2880
Fax Number : 512-864-2881
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2005
Last Update Date : 01/15/2009

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Directions to “ DR. RAYMOND T. DURHAM D.C.” Practice Location

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