Provider Demographics
NPI:1346480993
Name:BURCH, ROY FUNDERBURKE III (DC)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:FUNDERBURKE
Last Name:BURCH
Suffix:III
Gender:M
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 5537
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-5537
Mailing Address - Country:US
Mailing Address - Phone:843-669-5255
Mailing Address - Fax:843-669-5355
Practice Address - Street 1:2234 W PALMETTO ST
Practice Address - Street 2:SUITE C
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-4047
Practice Address - Country:US
Practice Address - Phone:843-669-5255
Practice Address - Fax:843-669-5355
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-23
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3426111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor