Provider Demographics
NPI:1578691168
Name:BURRIS, GREGORY EDWIN (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:EDWIN
Last Name:BURRIS
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:PO BOX 6355
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN
Mailing Address - State:AR
Mailing Address - Zip Code:72956-0242
Mailing Address - Country:US
Mailing Address - Phone:479-632-0688
Mailing Address - Fax:479-632-0688
Practice Address - Street 1:108 HIGHWAY 71 N
Practice Address - Street 2:SUITE 104
Practice Address - City:ALMA
Practice Address - State:AR
Practice Address - Zip Code:72921-5024
Practice Address - Country:US
Practice Address - Phone:479-632-0688
Practice Address - Fax:479-632-0688
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1618111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARU99207Medicare UPIN
AR5X694Medicare ID - Type UnspecifiedPERSONAL MEDICARE ID