Provider Demographics
NPI:1629633045
Name:BURNETT CHIROPRACTIC AND MASSAGE, INC
Entity Type:Organization
Organization Name:BURNETT CHIROPRACTIC AND MASSAGE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:BURNETT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:971-245-5699
Mailing Address - Street 1:12725 SW 66TH AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-2548
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:971-371-1129
Practice Address - Street 1:12725 SW 66TH AVE STE 205
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-2548
Practice Address - Country:US
Practice Address - Phone:503-360-3050
Practice Address - Fax:971-371-1129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-01
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1225363419OtherNPI