Provider Demographics
NPI:1093416786
Name:BURROW, MATTHEW TYLER (DC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:TYLER
Last Name:BURROW
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 1127
Mailing Address - Street 2:
Mailing Address - City:LOUISBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66053-1127
Mailing Address - Country:US
Mailing Address - Phone:913-980-4678
Mailing Address - Fax:
Practice Address - Street 1:15 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:LOUISBURG
Practice Address - State:KS
Practice Address - Zip Code:66053-3613
Practice Address - Country:US
Practice Address - Phone:913-837-2910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-06244111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor