Provider Demographics
NPI:1144417254
Name:BURGER CHIROPRACTIC L.L.C
Entity Type:Organization
Organization Name:BURGER CHIROPRACTIC L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:BURGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC,
Authorized Official - Phone:563-582-1188
Mailing Address - Street 1:989 LANGWORTHY ST STE 202
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-7368
Mailing Address - Country:US
Mailing Address - Phone:563-582-1188
Mailing Address - Fax:563-582-1181
Practice Address - Street 1:989 LANGWORTHY ST STE 202
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-7368
Practice Address - Country:US
Practice Address - Phone:563-582-1188
Practice Address - Fax:563-582-1181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06976261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1144417254Medicaid
IAI21218Medicare PIN