Provider Demographics
NPI:1417099631
Name:BURFORD, GLEN RAYMOND (DC)
Entity Type:Individual
Prefix:DR
First Name:GLEN
Middle Name:RAYMOND
Last Name:BURFORD
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 1:346 NEW BYHALIA RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017
Mailing Address - Country:US
Mailing Address - Phone:901-853-1734
Mailing Address - Fax:901-854-1166
Practice Address - Street 1:346 NEW BYHALIA RD
Practice Address - Street 2:SUITE 3
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017
Practice Address - Country:US
Practice Address - Phone:901-853-1734
Practice Address - Fax:901-854-1166
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC461111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3673910Medicare UPIN
TN3673910Medicare PIN