Provider Demographics
NPI:1699258020
Name:DURBIN, SAMUEL EDWARD JR (DC)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:EDWARD
Last Name:DURBIN
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:235 JUNGERMANN RD STE 209
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-5365
Mailing Address - Country:US
Mailing Address - Phone:636-928-7387
Mailing Address - Fax:636-928-1269
Practice Address - Street 1:235 JUNGERMANN RD STE 209
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376
Practice Address - Country:US
Practice Address - Phone:636-928-7387
Practice Address - Fax:636-928-1269
Is Sole Proprietor?:No
Enumeration Date:2018-09-11
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018032992111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor