Provider Demographics
NPI:1558603357
Name:BURNHAM CHIROPRACTIC ENTERPRISES LLC
Entity Type:Organization
Organization Name:BURNHAM CHIROPRACTIC ENTERPRISES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:904-310-4563
Mailing Address - Street 1:112 OLD JENNINGS RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-7505
Mailing Address - Country:US
Mailing Address - Phone:904-310-4563
Mailing Address - Fax:
Practice Address - Street 1:112 OLD JENNINGS RD
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065-7505
Practice Address - Country:US
Practice Address - Phone:904-310-4563
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-20
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CH9881111N00000X, 111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NI0013XChiropractic ProvidersChiropractorIndependent Medical ExaminerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFL949AOtherMEDICARE PTAN
FL004048000Medicaid