Provider Demographics
NPI:1235202490
Name:BURKE, LUCINDA (DC)
Entity Type:Individual
Prefix:
First Name:LUCINDA
Middle Name:
Last Name:BURKE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48371-4975
Mailing Address - Country:US
Mailing Address - Phone:248-628-2891
Mailing Address - Fax:248-800-4119
Practice Address - Street 1:142 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MI
Practice Address - Zip Code:48371-4975
Practice Address - Country:US
Practice Address - Phone:248-628-2891
Practice Address - Fax:248-800-4119
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILB004057111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU83983Medicare UPIN
MI0N25340Medicare ID - Type Unspecified