Provider Demographics
NPI:1104859057
Name:BURBACK, STEVEN EUGENE (ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:EUGENE
Last Name:BURBACK
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10711 ROSALIE DR
Mailing Address - Street 2:
Mailing Address - City:NORTHGLENN
Mailing Address - State:CO
Mailing Address - Zip Code:80233-3551
Mailing Address - Country:US
Mailing Address - Phone:505-392-0212
Mailing Address - Fax:
Practice Address - Street 1:6610 N LOVINGTON HWY
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-9120
Practice Address - Country:US
Practice Address - Phone:505-392-6561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3332255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM333OtherNEW MEXICO LICENSE NUMBER