Provider Demographics
NPI:1205232105
Name:S T BURNS INC
Entity Type:Organization
Organization Name:S T BURNS INC
Other - Org Name:BACK IN MOTION FAMILY AND SPORTS CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:315-261-4866
Mailing Address - Street 1:17 LEROY ST
Mailing Address - Street 2:
Mailing Address - City:POTSDAM
Mailing Address - State:NY
Mailing Address - Zip Code:13676-1737
Mailing Address - Country:US
Mailing Address - Phone:315-261-4866
Mailing Address - Fax:315-261-4867
Practice Address - Street 1:17 LEROY ST
Practice Address - Street 2:
Practice Address - City:POTSDAM
Practice Address - State:NY
Practice Address - Zip Code:13676-1737
Practice Address - Country:US
Practice Address - Phone:315-261-4866
Practice Address - Fax:315-261-4867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-05
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX012525111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ100208792Medicare PIN