Provider Demographics
NPI:1326190638
Name:BURKE-POWERS, KATHLEEN M (DC)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:M
Last Name:BURKE-POWERS
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:PO BOX 38
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:15091-0038
Mailing Address - Country:US
Mailing Address - Phone:412-487-1035
Mailing Address - Fax:412-487-1035
Practice Address - Street 1:2473 WILDWOOD ROAD
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:PA
Practice Address - Zip Code:15091
Practice Address - Country:US
Practice Address - Phone:412-487-1035
Practice Address - Fax:412-487-1035
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008047L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1323206OtherBLUE CROSS BLUE SHIELD
PA1323206OtherBLUE CROSS BLUE SHIELD