Provider Demographics
NPI:1518240449
Name:BURKHEAD, TAMARA LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:LYNN
Last Name:BURKHEAD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 WEST JEFFERSON ST.
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:FL
Mailing Address - Zip Code:32351-2212
Mailing Address - Country:US
Mailing Address - Phone:850-875-1747
Mailing Address - Fax:850-627-3853
Practice Address - Street 1:1102 WEST JEFFERSON ST.
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:FL
Practice Address - Zip Code:32351-2212
Practice Address - Country:US
Practice Address - Phone:850-875-1747
Practice Address - Fax:850-627-3853
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008685111N00000X
FLCH 10451111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor