Provider Demographics
NPI:1619390903
Name:BURNHAM CHIROPRACTIC ENTERPRISES, LLC
Entity Type:Organization
Organization Name:BURNHAM CHIROPRACTIC ENTERPRISES, LLC
Other - Org Name:BURNHAM CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:M
Authorized Official - Last Name:BURNHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:904-803-2982
Mailing Address - Street 1:461 KINGSLEY AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4827
Mailing Address - Country:US
Mailing Address - Phone:904-310-4563
Mailing Address - Fax:904-639-5220
Practice Address - Street 1:461 KINGSLEY AVE
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4827
Practice Address - Country:US
Practice Address - Phone:904-310-4563
Practice Address - Fax:904-639-5220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9881111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty