Provider Demographics
NPI:1477807071
Name:BURT, AUSTIN MITCHELL (DC)
Entity Type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:MITCHELL
Last Name:BURT
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 1:790 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WALCOTT
Mailing Address - State:IA
Mailing Address - Zip Code:52773-9505
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:790 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WALCOTT
Practice Address - State:IA
Practice Address - Zip Code:52773-9505
Practice Address - Country:US
Practice Address - Phone:563-284-6927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-04
Last Update Date:2012-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007588111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor