Provider Demographics
NPI:1659983716
Name:BURTIS, KATHERINE (DC)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:
Last Name:BURTIS
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 1:121 VICTORIA COMMONS BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-7772
Mailing Address - Country:US
Mailing Address - Phone:386-873-4787
Mailing Address - Fax:
Practice Address - Street 1:121 VICTORIA COMMONS BLVD STE 106
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-7772
Practice Address - Country:US
Practice Address - Phone:386-873-4787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH13105111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor