Provider Demographics
NPI:1669660247
Name:BURLE CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:BURLE CHIROPRACTIC INC.
Other - Org Name:BURLE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OENER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:BURLE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:573-581-0381
Mailing Address - Street 1:422 W LOVE ST
Mailing Address - Street 2:
Mailing Address - City:MEXICO
Mailing Address - State:MO
Mailing Address - Zip Code:65265-2704
Mailing Address - Country:US
Mailing Address - Phone:573-581-0381
Mailing Address - Fax:573-581-0381
Practice Address - Street 1:422 W LOVE ST
Practice Address - Street 2:
Practice Address - City:MEXICO
Practice Address - State:MO
Practice Address - Zip Code:65265-2704
Practice Address - Country:US
Practice Address - Phone:573-581-0381
Practice Address - Fax:573-581-0381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007021191111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty