Provider Demographics
NPI:1184664203
Name:BURRILL, KEVIN D (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:D
Last Name:BURRILL
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 1:2600 66TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-3123
Mailing Address - Country:US
Mailing Address - Phone:727-381-3600
Mailing Address - Fax:727-343-6277
Practice Address - Street 1:2600 66TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-3123
Practice Address - Country:US
Practice Address - Phone:727-381-3600
Practice Address - Fax:727-343-6277
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006469111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
22856ZMedicare PIN
FLCU40994Medicare UPIN