Provider Demographics
NPI:1528229218
Name:BURG, RICHARD WARD (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:WARD
Last Name:BURG
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 1:6330 TELEGRAPH AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-1329
Mailing Address - Country:US
Mailing Address - Phone:510-601-6330
Mailing Address - Fax:510-601-6331
Practice Address - Street 1:6330 TELEGRAPH AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1329
Practice Address - Country:US
Practice Address - Phone:510-601-6330
Practice Address - Fax:510-601-6331
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-24
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-30950111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition