Provider Demographics
NPI:1083667752
Name:BURLESON, JIMMY ALBERT (DC)
Entity Type:Individual
Prefix:
First Name:JIMMY
Middle Name:ALBERT
Last Name:BURLESON
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:PO BOX 18305
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27419-8305
Mailing Address - Country:US
Mailing Address - Phone:336-274-3500
Mailing Address - Fax:336-292-1928
Practice Address - Street 1:3410 W WENDOVER AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-1585
Practice Address - Country:US
Practice Address - Phone:336-274-3500
Practice Address - Fax:336-292-1928
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2262111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor