Provider Demographics
NPI:1417972936
Name:BURKE, ERWIN L (DC)
Entity Type:Individual
Prefix:
First Name:ERWIN
Middle Name:L
Last Name:BURKE
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:PO BOX 503
Mailing Address - Street 2:203 COUCH ST.
Mailing Address - City:ALTON
Mailing Address - State:MO
Mailing Address - Zip Code:65606-0503
Mailing Address - Country:US
Mailing Address - Phone:417-778-2100
Mailing Address - Fax:417-778-2103
Practice Address - Street 1:203 COUCH ST.
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:MO
Practice Address - Zip Code:65606-0503
Practice Address - Country:US
Practice Address - Phone:417-778-2100
Practice Address - Fax:417-778-2103
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004034207111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201977OtherBLUE-CROSS BLUE SHIELD
MO733477OtherHEALTHLINK
MO756242509Medicaid
MO5653917OtherFIRST HEALTH
MO697592OtherACN GROUP
MOP00302638Medicare ID - Type UnspecifiedRAIL ROAD MEDICARE
MO000025852Medicare ID - Type UnspecifiedMEDICARE