Provider Demographics
NPI:1710272869
Name:BURNS, JACK NEELAN JR (DC)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:NEELAN
Last Name:BURNS
Suffix:JR
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 1:1411 W 7TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732-3522
Mailing Address - Country:US
Mailing Address - Phone:310-831-5550
Mailing Address - Fax:310-669-3094
Practice Address - Street 1:1411 W 7TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732-3522
Practice Address - Country:US
Practice Address - Phone:310-831-5550
Practice Address - Fax:310-669-3094
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24301111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor