Provider Demographics
NPI:1356331367
Name:BURKHOLDER, BRIAN (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:BURKHOLDER
Suffix:
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 1:22833 BOTHELL EVERETT HWY
Mailing Address - Street 2:STE 202
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-9368
Mailing Address - Country:US
Mailing Address - Phone:408-364-6600
Mailing Address - Fax:408-364-2041
Practice Address - Street 1:18805 COX AVENUE
Practice Address - Street 2:SUITE #170
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070-4162
Practice Address - Country:US
Practice Address - Phone:408-364-6600
Practice Address - Fax:408-364-2041
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-21
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034664111N00000X
CADC 27313111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADCO273130Medicare ID - Type UnspecifiedMEDICARE