Provider Demographics
NPI:1528121704
Name:DURHAM CHIROPRACTIC, P.C.
Entity type:Organization
Organization Name:DURHAM CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:PREBECK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:919-544-9355
Mailing Address - Street 1:5322 HIGHGATE DR
Mailing Address - Street 2:SUITE 145
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6633
Mailing Address - Country:US
Mailing Address - Phone:919-544-9355
Mailing Address - Fax:919-544-9494
Practice Address - Street 1:5322 HIGHGATE DR
Practice Address - Street 2:SUITE 145
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-6633
Practice Address - Country:US
Practice Address - Phone:919-544-9355
Practice Address - Fax:919-544-9494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2295111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890823JMedicaid
NC0823JOtherBLUE CROSS & BLUE SHIELD
NC2451314Medicare ID - Type Unspecified