Provider Demographics
NPI:1437198975
Name:BURKE, ALAN LEE (MADC)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:LEE
Last Name:BURKE
Suffix:
Gender:M
Credentials:MADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 W. EATON AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-3865
Mailing Address - Country:US
Mailing Address - Phone:209-836-2225
Mailing Address - Fax:209-836-2142
Practice Address - Street 1:550 W EATON AVE
Practice Address - Street 2:SUITE B
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-3422
Practice Address - Country:US
Practice Address - Phone:209-836-2225
Practice Address - Fax:209-836-2142
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC11700111NT0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NT0100XChiropractic ProvidersChiropractorThermography
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0117001Medicare PIN