Provider Demographics
NPI:1578501755
Name:BURKE, MICHAEL J (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:BURKE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:J.
Other - Middle Name:MICHAEL
Other - Last Name:BURKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:3661 NATALIE WAY
Mailing Address - Street 2:
Mailing Address - City:BANDON
Mailing Address - State:OR
Mailing Address - Zip Code:97411
Mailing Address - Country:US
Mailing Address - Phone:503-701-8649
Mailing Address - Fax:
Practice Address - Street 1:576 DONNELLY AVE
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-1555
Practice Address - Country:US
Practice Address - Phone:541-266-7543
Practice Address - Fax:541-269-9408
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27 1595111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR0000QGCDWMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER