Provider Demographics
NPI:1235777467
Name:FUNCTIONAL AIM CHIROPRACTIC
Entity Type:Organization
Organization Name:FUNCTIONAL AIM CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:469-265-8591
Mailing Address - Street 1:5307 ARGYLE WAY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-5812
Mailing Address - Country:US
Mailing Address - Phone:469-265-8591
Mailing Address - Fax:
Practice Address - Street 1:7300 BLANCO RD STE 503
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-4941
Practice Address - Country:US
Practice Address - Phone:469-265-8591
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty