Provider Demographics
NPI:1609853589
Name:BURNS, J. RICHARD (DC)
Entity Type:Individual
Prefix:DR
First Name:J.
Middle Name:RICHARD
Last Name:BURNS
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 1:379 AVENUE OF THE CITIES
Mailing Address - Street 2:
Mailing Address - City:EAST MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61244-4023
Mailing Address - Country:US
Mailing Address - Phone:309-755-4400
Mailing Address - Fax:309-755-2163
Practice Address - Street 1:379 AVENUE OF THE CITIES
Practice Address - Street 2:
Practice Address - City:EAST MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61244-4023
Practice Address - Country:US
Practice Address - Phone:309-755-4400
Practice Address - Fax:309-755-2163
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL38-3520111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL08182032OtherBLUE CROSS/ BLUE SHIELD
IL612750Medicare ID - Type Unspecified
ILT37249Medicare UPIN