Provider Demographics
NPI:1104844828
Name:BURKE-SEARLS, TEDRA L (DC)
Entity Type:Individual
Prefix:
First Name:TEDRA
Middle Name:L
Last Name:BURKE-SEARLS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1822 W KETTLEMAN LN STE 5
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95242-4218
Mailing Address - Country:US
Mailing Address - Phone:209-334-2841
Mailing Address - Fax:209-334-2307
Practice Address - Street 1:1822 W KETTLEMAN LN STE 5
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-4218
Practice Address - Country:US
Practice Address - Phone:209-334-2841
Practice Address - Fax:209-334-2307
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24095111N00000X
IDCHIA-1769111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU65157Medicare UPIN
CADC0240950Medicare ID - Type Unspecified