Provider Demographics
NPI:1710423454
Name:BURK, JORDAN (L AC)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:BURK
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264B HAWKEEGAN DR
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-3913
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1795 ALYSHEBA WAY
Practice Address - Street 2:#1102
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2280
Practice Address - Country:US
Practice Address - Phone:502-321-3881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTAC102171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist