Provider Demographics
NPI:1043363112
Name:BURTON, MARY ELLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ELLEN
Last Name:BURTON
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 1:307 E PARK AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ANACONDA
Mailing Address - State:MT
Mailing Address - Zip Code:59711-2351
Mailing Address - Country:US
Mailing Address - Phone:406-224-3076
Mailing Address - Fax:406-563-5393
Practice Address - Street 1:307 E PARK AVE
Practice Address - Street 2:STE 204
Practice Address - City:ANACONDA
Practice Address - State:MT
Practice Address - Zip Code:59711-2351
Practice Address - Country:US
Practice Address - Phone:406-224-3076
Practice Address - Fax:406-563-5393
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008124111NR0400X
MTCHI-CHI-LIC-2372111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
463217824OtherEIN
511I350163Medicare PIN