Provider Demographics
NPI:1528196920
Name:BURKE, JASON LAWRENCE (LAC)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:LAWRENCE
Last Name:BURKE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7525 8TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20012-1813
Mailing Address - Country:US
Mailing Address - Phone:202-309-4958
Mailing Address - Fax:
Practice Address - Street 1:7525 8TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012-1813
Practice Address - Country:US
Practice Address - Phone:202-309-4958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCAC500192171100000X
IAA-53171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist