MEDICARE: DR. ROBERT M. DURHAM DC

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
1	111N00000X	Chiropractor	1600	SC

General Provider Information

NPI Number	:	1609850924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT M. DURHAM DC

Provider Business Mailing Address
First Line	:	107 RIVER DR
Second Line	:
City	:	WILLIAMSTON
State	:	SC
Zip	:	29697-2018
Country	:	US
Telephone Number	:	864-847-1849
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 GREENVILLE DR
Second Line	:
City	:	WILLIAMSTON
State	:	SC
Zip	:	29697-1130
Country	:	US
Telephone Number	:	864-847-1818
Fax Number	:	864-847-5706

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	11/29/2011

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