Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC10083 | TX |
N | 111NP0017X | Pediatric Chiropractor | 10083 | TX |
NPI | 1740337419 |
---|---|
Provider Name | Dr. Misty Michelle Durbin |
First Address | Corpus Christi, TX 78411-4761 |
Second Address | Corpus Christi, TX 78411-4761 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2007 |
Last Update Date | 17/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
317335301 | (05) | TX |