Provider Demographics
NPI:1629025622
Name:HENRY BURNETT, ELIZABETH A (DC)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:A
Last Name:HENRY BURNETT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:A
Other - Last Name:HENRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22295 HIGHWAY 6 AND 19
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE SPRINGS
Mailing Address - State:PA
Mailing Address - Zip Code:16403
Mailing Address - Country:US
Mailing Address - Phone:814-398-2887
Mailing Address - Fax:
Practice Address - Street 1:22295 HIGHWAY 6 AND 19
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE SPRINGS
Practice Address - State:PA
Practice Address - Zip Code:16403
Practice Address - Country:US
Practice Address - Phone:814-398-2887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008869111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019514330001Medicaid
PA0019514330001Medicaid
PAU94537Medicare UPIN