Provider Demographics
NPI:1881687317
Name:BURNS, JEFFREY D (DC)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:D
Last Name:BURNS
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 1:1210 W 18TH ST
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:IA
Mailing Address - Zip Code:51301-2817
Mailing Address - Country:US
Mailing Address - Phone:712-262-7252
Mailing Address - Fax:712-262-4557
Practice Address - Street 1:1210 W 18TH ST
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-2817
Practice Address - Country:US
Practice Address - Phone:712-262-7252
Practice Address - Fax:712-262-4557
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05456111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0288431Medicaid
28843Medicare ID - Type Unspecified
U01948Medicare UPIN