Provider Demographics
NPI:1790840759
Name:BURLESON, VICTORIA (DC)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:
Last Name:BURLESON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:BURLESON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:807 WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-4221
Mailing Address - Country:US
Mailing Address - Phone:251-626-9898
Mailing Address - Fax:
Practice Address - Street 1:807 WILSON AVE
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-4221
Practice Address - Country:US
Practice Address - Phone:251-626-9898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1711111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000060635Medicare ID - Type Unspecified
ALU61726Medicare UPIN