Provider Demographics
NPI:1619061488
Name:BURKE, JAMES LOWELL (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LOWELL
Last Name:BURKE
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 1:3190 MARTIN LUTHER KING ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33704-2037
Mailing Address - Country:US
Mailing Address - Phone:728-686-4852
Mailing Address - Fax:727-894-3476
Practice Address - Street 1:3200 4TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33704-2127
Practice Address - Country:US
Practice Address - Phone:727-823-3151
Practice Address - Fax:727-821-2419
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6796111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL380653700Medicaid
FL55183ZMedicare ID - Type Unspecified
FL380653700Medicaid