Provider Demographics
NPI:1003188954
Name:BURKE, KIMBERLY V (DC)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:V
Last Name:BURKE
Suffix:
Gender:F
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:PO BOX 1666
Mailing Address - Street 2:5 UPPER DOUGLAS LN.
Mailing Address - City:OAK BLUFFS
Mailing Address - State:MA
Mailing Address - Zip Code:02557-1666
Mailing Address - Country:US
Mailing Address - Phone:508-687-9320
Mailing Address - Fax:508-684-8457
Practice Address - Street 1:5 UPPER DOUGLAS LN
Practice Address - Street 2:
Practice Address - City:OAK BLUFFS
Practice Address - State:MA
Practice Address - Zip Code:02557
Practice Address - Country:US
Practice Address - Phone:508-687-9320
Practice Address - Fax:507-684-8457
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-07
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3360111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor