Provider Demographics
NPI:1083759674
Name:BURACK, JONATHAN (DC)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:
Last Name:BURACK
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 1:871 S GOVERNORS AVE
Mailing Address - Street 2:STE 2
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904
Mailing Address - Country:US
Mailing Address - Phone:302-734-1150
Mailing Address - Fax:302-734-1160
Practice Address - Street 1:871 S GOVERNORS AVE
Practice Address - Street 2:STE 2
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904
Practice Address - Country:US
Practice Address - Phone:302-734-1150
Practice Address - Fax:302-734-1160
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEFI0000580111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
V00382Medicare UPIN
DE491772Medicare ID - Type Unspecified