Provider Demographics
NPI:1205847969
Name:BURGESS, BRADFORD LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:BRADFORD
Middle Name:LYNN
Last Name:BURGESS
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 1:123 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28081
Mailing Address - Country:US
Mailing Address - Phone:704-933-2225
Mailing Address - Fax:704-933-8855
Practice Address - Street 1:123 S MAIN ST
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28081
Practice Address - Country:US
Practice Address - Phone:704-933-2225
Practice Address - Fax:704-933-8855
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC834111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8908280Medicaid
T64279Medicare UPIN
2442033Medicare ID - Type Unspecified