Provider Demographics
NPI:1710091939
Name:LAURIE C. BURKE, DOCTOR OF CHIROPRACTIC P.C.
Entity Type:Organization
Organization Name:LAURIE C. BURKE, DOCTOR OF CHIROPRACTIC P.C.
Other - Org Name:CLARKSON CHIROPRACTIC CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:636-227-8191
Mailing Address - Street 1:242 CLARKSON RD
Mailing Address - Street 2:
Mailing Address - City:ELLISVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2245
Mailing Address - Country:US
Mailing Address - Phone:636-227-8191
Mailing Address - Fax:
Practice Address - Street 1:242 CLARKSON RD
Practice Address - Street 2:
Practice Address - City:ELLISVILLE
Practice Address - State:MO
Practice Address - Zip Code:63011-2245
Practice Address - Country:US
Practice Address - Phone:636-227-8191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004760111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000015183Medicare PIN
MO5916090001Medicare NSC