Provider Demographics
NPI:1760678262
Name:BURDETTE CHIROPRACTIC, INCORPORATED
Entity Type:Organization
Organization Name:BURDETTE CHIROPRACTIC, INCORPORATED
Other - Org Name:COMMUNITY CHIROPRACTIC CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:WEAVER
Authorized Official - Last Name:BURDETTE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:858-486-1222
Mailing Address - Street 1:PO BOX 807
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92074-0807
Mailing Address - Country:US
Mailing Address - Phone:858-486-1222
Mailing Address - Fax:
Practice Address - Street 1:13029 POMERADO RD
Practice Address - Street 2:SUITE A
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-4246
Practice Address - Country:US
Practice Address - Phone:858-486-1222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27393111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty