Provider Demographics
NPI:1932359627
Name:DURDEN CHIROPRACTIC CLINIC, INC.
Entity type:Organization
Organization Name:DURDEN CHIROPRACTIC CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:L
Authorized Official - Last Name:DURDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-631-7600
Mailing Address - Street 1:PO BOX 142216
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-6511
Mailing Address - Country:US
Mailing Address - Phone:770-631-7600
Mailing Address - Fax:
Practice Address - Street 1:120 HANDLEY RD
Practice Address - Street 2:SUITE 220
Practice Address - City:TYRONE
Practice Address - State:GA
Practice Address - Zip Code:30290-2177
Practice Address - Country:US
Practice Address - Phone:770-631-7600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-30
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511G700978Medicare PIN