Provider Demographics
NPI:1801404249
Name:BURGETT, AUSTIN (DC)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:
Last Name:BURGETT
Suffix:
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 1:11605 MERIDIAN MARKET VW STE 142
Mailing Address - Street 2:
Mailing Address - City:FALCON
Mailing Address - State:CO
Mailing Address - Zip Code:80831-8238
Mailing Address - Country:US
Mailing Address - Phone:719-559-3921
Mailing Address - Fax:
Practice Address - Street 1:11605 MERIDIAN MARKET VW STE 142
Practice Address - Street 2:
Practice Address - City:FALCON
Practice Address - State:CO
Practice Address - Zip Code:80831-8238
Practice Address - Country:US
Practice Address - Phone:719-559-3921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8229111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor