Provider Demographics
NPI:1598937179
Name:BURLEY CHIROPRACTIC PC
Entity Type:Organization
Organization Name:BURLEY CHIROPRACTIC PC
Other - Org Name:JOELTON CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLEY
Authorized Official - Middle Name:S
Authorized Official - Last Name:BURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-876-9936
Mailing Address - Street 1:205 GIFFORD PLACE
Mailing Address - Street 2:
Mailing Address - City:JOELTON
Mailing Address - State:TN
Mailing Address - Zip Code:37080
Mailing Address - Country:US
Mailing Address - Phone:615-876-9936
Mailing Address - Fax:615-876-9908
Practice Address - Street 1:205 GIFFORD PLACE
Practice Address - Street 2:
Practice Address - City:JOELTON
Practice Address - State:TN
Practice Address - Zip Code:37080
Practice Address - Country:US
Practice Address - Phone:615-876-9936
Practice Address - Fax:615-876-9908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC01465111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4056858OtherBCBS OF TN
TN6850315OtherCIGNA
TN6850315OtherCIGNA