Provider Demographics
NPI:1699925677
Name:DURLACHER ENTERPRISES INC
Entity type:Organization
Organization Name:DURLACHER ENTERPRISES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:V
Authorized Official - Last Name:DURLACHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-827-2044
Mailing Address - Street 1:1215 E BROWN RD STE 3
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-5046
Mailing Address - Country:US
Mailing Address - Phone:480-827-2044
Mailing Address - Fax:480-222-0127
Practice Address - Street 1:1215 E BROWN RD STE 3
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-5046
Practice Address - Country:US
Practice Address - Phone:480-827-2044
Practice Address - Fax:480-222-0127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-25
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4230111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0937210OtherBCBS
AZT00243Medicare UPIN
AZZ125033Medicare PIN