Provider Demographics
NPI:1275793812
Name:BURNETTE, BAMBI
Entity Type:Individual
Prefix:DR
First Name:BAMBI
Middle Name:
Last Name:BURNETTE
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:BAMBI
Other - Middle Name:BURNETTE
Other - Last Name:BALA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1112 S TELEPHONE POINT RD
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34450-3505
Mailing Address - Country:US
Mailing Address - Phone:352-476-8752
Mailing Address - Fax:
Practice Address - Street 1:6 W LEMON ST
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:FL
Practice Address - Zip Code:34465-3253
Practice Address - Country:US
Practice Address - Phone:352-476-8752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6674111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor