Provider Demographics
NPI:1376550590
Name:BURTON, RALPH (DC)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:
Last Name:BURTON
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 1:203 STATE HIGHWAY 110N
Mailing Address - Street 2:#3
Mailing Address - City:WHITEHOUSE
Mailing Address - State:TX
Mailing Address - Zip Code:75791-3113
Mailing Address - Country:US
Mailing Address - Phone:903-839-9355
Mailing Address - Fax:903-839-8783
Practice Address - Street 1:203 STATE HWY 110 N
Practice Address - Street 2:#3
Practice Address - City:WHITEHOUSE
Practice Address - State:TX
Practice Address - Zip Code:75791-3113
Practice Address - Country:US
Practice Address - Phone:903-839-9355
Practice Address - Fax:903-839-8783
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5238111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX604029OtherBLUECROSS BLUESHIELD TX
TX5403666OtherCCN NETWORK
TX5238OtherSTATE LICENSE NUMBER
TX627712OtherACN GROUP NUMBER
TX650409OtherFIRST HEALTH NETWORK
TX604029OtherBLUECROSS BLUESHIELD TX
TX650409OtherFIRST HEALTH NETWORK