Provider Demographics
NPI:1760833552
Name:BURT, BRIANNA D (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIANNA
Middle Name:D
Last Name:BURT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:BRIANNA
Other - Middle Name:D
Other - Last Name:FORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:5959 SHALLOWFORD RD
Mailing Address - Street 2:SUITE 527
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421
Mailing Address - Country:US
Mailing Address - Phone:423-499-0102
Mailing Address - Fax:423-499-9857
Practice Address - Street 1:5959 SHALLOWFORD RD
Practice Address - Street 2:SUITE 527
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421
Practice Address - Country:US
Practice Address - Phone:423-499-0102
Practice Address - Fax:423-499-9857
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2872111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor