Provider Demographics
NPI:1881671964
Name:BURKE, RICHARD ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALAN
Last Name:BURKE
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 1:26031 W WARREN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-4716
Mailing Address - Country:US
Mailing Address - Phone:313-565-5800
Mailing Address - Fax:313-565-5535
Practice Address - Street 1:26031 W WARREN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-4716
Practice Address - Country:US
Practice Address - Phone:313-565-5800
Practice Address - Fax:313-565-5535
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI004234111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIT33824Medicare UPIN