Provider Demographics
NPI:1063547248
Name:DURBIN, DUSTIN WILLIAM (DC)
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:WILLIAM
Last Name:DURBIN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8305 N ALLEN RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-1815
Mailing Address - Country:US
Mailing Address - Phone:309-692-2121
Mailing Address - Fax:309-692-4747
Practice Address - Street 1:8305 N ALLEN RD
Practice Address - Street 2:SUITE 7
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-1815
Practice Address - Country:US
Practice Address - Phone:309-692-2121
Practice Address - Fax:309-692-4747
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-010466111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor