Provider Demographics
NPI:1114248598
Name:BURNHAM, JOSEPH MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:MICHAEL
Last Name:BURNHAM
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 1:155 BLANDING BLVD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-2630
Mailing Address - Country:US
Mailing Address - Phone:904-803-2982
Mailing Address - Fax:904-213-9806
Practice Address - Street 1:155 BLANDING BLVD
Practice Address - Street 2:SUITE 8
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-2630
Practice Address - Country:US
Practice Address - Phone:904-803-2982
Practice Address - Fax:904-213-9806
Is Sole Proprietor?:No
Enumeration Date:2010-06-19
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 9801111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor