Provider Demographics
NPI:1093753667
Name:BURBANK, WADE DEAN (DC)
Entity Type:Individual
Prefix:DR
First Name:WADE
Middle Name:DEAN
Last Name:BURBANK
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 1:6403 NE 117TH AVE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-5560
Mailing Address - Country:US
Mailing Address - Phone:360-567-1739
Mailing Address - Fax:360-256-0300
Practice Address - Street 1:6403 NE 117TH AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-5560
Practice Address - Country:US
Practice Address - Phone:360-567-1739
Practice Address - Fax:360-256-0300
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00033654111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB39769Medicare PIN
WAU97071Medicare UPIN