Provider Demographics
NPI:1639248230
Name:BURKE, ALICIA MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:MARIE
Last Name:BURKE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:554 S SAN VICENTE BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-4652
Mailing Address - Country:US
Mailing Address - Phone:323-951-0001
Mailing Address - Fax:323-951-0063
Practice Address - Street 1:554 S SAN VICENTE BLVD STE 103
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4652
Practice Address - Country:US
Practice Address - Phone:323-951-0001
Practice Address - Fax:323-951-0063
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26353111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC26353Medicare ID - Type Unspecified