Provider Demographics
NPI:1568730372
Name:BURTON CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:BURTON CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRANKLIN
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:812-384-8025
Mailing Address - Street 1:PO BOX 424
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:47424-0424
Mailing Address - Country:US
Mailing Address - Phone:812-384-8025
Mailing Address - Fax:812-384-8175
Practice Address - Street 1:505 S. FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:IN
Practice Address - Zip Code:47424-0424
Practice Address - Country:US
Practice Address - Phone:812-384-8025
Practice Address - Fax:812-384-8175
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BURTON CHIROPRACTIC CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-07
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000557A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty