Provider Demographics
NPI:1730371014
Name:DEVOLLD, DUNCAN CHURCH (DC)
Entity type:Individual
Prefix:DR
First Name:DUNCAN
Middle Name:CHURCH
Last Name:DEVOLLD
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 1:301B MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29582-3022
Mailing Address - Country:US
Mailing Address - Phone:843-249-6543
Mailing Address - Fax:843-280-0837
Practice Address - Street 1:301B MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582-3022
Practice Address - Country:US
Practice Address - Phone:843-249-6543
Practice Address - Fax:843-280-0837
Is Sole Proprietor?:No
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1308111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH1308Medicaid
SCU115480281Medicare UPIN