Provider Demographics
NPI:1811423387
Name:BURKS, CORY LANNAN (DC)
Entity Type:Individual
Prefix:DR
First Name:CORY
Middle Name:LANNAN
Last Name:BURKS
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 1:122 CYPRESS CIR
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-7300
Mailing Address - Country:US
Mailing Address - Phone:504-554-4520
Mailing Address - Fax:
Practice Address - Street 1:122 CYPRESS CIR
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-7300
Practice Address - Country:US
Practice Address - Phone:504-554-4520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4769111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor