Provider Demographics
NPI:1225759608
Name:BURNLEY SPINE & SPORT CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:BURNLEY SPINE & SPORT CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:CARY
Authorized Official - Last Name:BURNLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:256-366-1976
Mailing Address - Street 1:501 E DR HICKS BLVD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-5738
Mailing Address - Country:US
Mailing Address - Phone:256-469-2035
Mailing Address - Fax:256-469-2031
Practice Address - Street 1:501 E. DOCTOR HICKS BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630
Practice Address - Country:US
Practice Address - Phone:256-469-2035
Practice Address - Fax:256-469-2031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-06
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
11551235OtherCAQH
AL31206OtherBCBS