Provider Demographics
NPI:1093156143
Name:KIMBERLY V BURKE
Entity Type:Organization
Organization Name:KIMBERLY V BURKE
Other - Org Name:ISLAND SPINE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:V
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:508-687-9320
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:608-684-8457
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:508-684-8457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3360111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty