Provider Demographics
NPI:1780317040
Name:PALM BAY CHIROPRACTIC AND WELLNESS, PLLC
Entity type:Organization
Organization Name:PALM BAY CHIROPRACTIC AND WELLNESS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:DURKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:321-499-4608
Mailing Address - Street 1:490 CENTRE LAKE DR NE STE 100A
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-1113
Mailing Address - Country:US
Mailing Address - Phone:321-499-4608
Mailing Address - Fax:321-499-4607
Practice Address - Street 1:490 CENTRE LAKE DR NE STE 100A
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-1113
Practice Address - Country:US
Practice Address - Phone:321-499-4608
Practice Address - Fax:321-499-4607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-05
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCH11572OtherCHIROPRACTIC LICENSE