Provider Demographics
NPI:1407926579
Name:BURKHART, DANIEL E (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:E
Last Name:BURKHART
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 1:520 S ORCHARD ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-1240
Mailing Address - Country:US
Mailing Address - Phone:208-906-2051
Mailing Address - Fax:
Practice Address - Street 1:520 S ORCHARD ST
Practice Address - Street 2:SUITE 101
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-1240
Practice Address - Country:US
Practice Address - Phone:208-906-2051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA1023111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor