Provider Demographics
NPI:1518190545
Name:BURGESS CHIROPRACTIC PA
Entity Type:Organization
Organization Name:BURGESS CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:BURGESS
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:940-243-0108
Mailing Address - Street 1:1100 DALLAS DR STE 112
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76205-5121
Mailing Address - Country:US
Mailing Address - Phone:940-243-0108
Mailing Address - Fax:940-387-3446
Practice Address - Street 1:1100 DALLAS DR STE 112
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76205-5121
Practice Address - Country:US
Practice Address - Phone:940-243-0108
Practice Address - Fax:940-387-3446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-25
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9347261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
11195715OtherUNITED HEALTH CARE
TX1891816716OtherWELLCARE
TX8H9157OtherBLUE CROSS/BLUE SHIELD
FL1891816716OtherINTEGRATED HEALTH PLAN, INC.
TN1891816716OtherFIRST HEALTH (COVENTRY)
TX1549388-01Medicaid
NJ1891816716OtherPHCS
KY1891816716OtherHUMANA
TX1549388-01Medicaid