Provider Demographics
NPI:1578517843
Name:BURGESS, DALE C (CHIROPRACTOR)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:C
Last Name:BURGESS
Suffix:
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 MCCLELLAN BLVD
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36201-2724
Mailing Address - Country:US
Mailing Address - Phone:256-237-9251
Mailing Address - Fax:256-236-7397
Practice Address - Street 1:3001 MCCLELLAN BLVD
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36201-2724
Practice Address - Country:US
Practice Address - Phone:256-237-9251
Practice Address - Fax:256-236-7397
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL915111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51505603OtherBLUE CROSS
AL51505603OtherBLUE CROSS
AL631278935OtherTAX ID NUMBER
ALT68345Medicare UPIN