Provider Demographics
NPI:1841413705
Name:BURMEISTER, GREGORY JON (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:JON
Last Name:BURMEISTER
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 1:316 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:EAGLE GROVE
Mailing Address - State:IA
Mailing Address - Zip Code:50533-2027
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:318 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:EAGLE GROVE
Practice Address - State:IA
Practice Address - Zip Code:50533-1712
Practice Address - Country:US
Practice Address - Phone:515-448-3387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAAO5314111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0257709Medicaid
IA1194774620OtherBUSINESS NPI NUMBER
IA26467OtherWELLMARK PROVIDER NUMBER
IA1194774620OtherBUSINESS NPI NUMBER
IA0257709Medicaid