Provider Demographics
NPI:1225363419
Name:BURNETT, DANIEL (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:BURNETT
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 1:12725 SW 66TH AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-2548
Mailing Address - Country:US
Mailing Address - Phone:971-245-5699
Mailing Address - Fax:971-371-1129
Practice Address - Street 1:12725 SW 66TH AVE STE 205
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-2548
Practice Address - Country:US
Practice Address - Phone:971-245-5699
Practice Address - Fax:971-371-1129
Is Sole Proprietor?:No
Enumeration Date:2009-10-06
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3965111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor