Provider Demographics
NPI:1710214986
Name:BURNS, JENNIFER ELOISE (DC)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ELOISE
Last Name:BURNS
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 1:3020 BRIDGEWAY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SAUSALITO
Mailing Address - State:CA
Mailing Address - Zip Code:94965-1439
Mailing Address - Country:US
Mailing Address - Phone:415-887-9689
Mailing Address - Fax:
Practice Address - Street 1:3020 BRIDGEWAY
Practice Address - Street 2:SUITE 103
Practice Address - City:SAUSALITO
Practice Address - State:CA
Practice Address - Zip Code:94965-1439
Practice Address - Country:US
Practice Address - Phone:415-887-9689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-09
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 31394111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor