Provider Demographics
NPI:1629263009
Name:BURKE, JOHN LONERGAN JR (ND,LAC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LONERGAN
Last Name:BURKE
Suffix:JR
Gender:M
Credentials:ND,LAC
Other - Prefix:DR
Other - First Name:JACK
Other - Middle Name:
Other - Last Name:BURKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ND,LAC
Mailing Address - Street 1:41-044 ALOILOI ST
Mailing Address - Street 2:
Mailing Address - City:WAIMANALO
Mailing Address - State:HI
Mailing Address - Zip Code:96795-1622
Mailing Address - Country:US
Mailing Address - Phone:808-259-6889
Mailing Address - Fax:
Practice Address - Street 1:41-044 ALOILOI ST
Practice Address - Street 2:
Practice Address - City:WAIMANALO
Practice Address - State:HI
Practice Address - Zip Code:96795-1622
Practice Address - Country:US
Practice Address - Phone:808-259-6889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI159171100000X
HI72175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist