Provider Demographics
NPI:1710170535
Name:BURBANK, JEFFREY ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ALLEN
Last Name:BURBANK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 N CLARK ST
Mailing Address - Street 2:
Mailing Address - City:CARROLL
Mailing Address - State:IA
Mailing Address - Zip Code:51401-2534
Mailing Address - Country:US
Mailing Address - Phone:712-792-4600
Mailing Address - Fax:712-792-7775
Practice Address - Street 1:715 N CLARK ST
Practice Address - Street 2:
Practice Address - City:CARROLL
Practice Address - State:IA
Practice Address - Zip Code:51401-2534
Practice Address - Country:US
Practice Address - Phone:712-792-4600
Practice Address - Fax:712-792-7775
Is Sole Proprietor?:No
Enumeration Date:2007-08-24
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007525111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor