Provider Demographics
NPI:1922034784
Name:DEAN EARL BURCHENSON, D.C., P.C.
Entity Type:Organization
Organization Name:DEAN EARL BURCHENSON, D.C., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:BURCHENSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:708-691-5823
Mailing Address - Street 1:2446 WEST LINCOLN HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461
Mailing Address - Country:US
Mailing Address - Phone:708-481-7722
Mailing Address - Fax:708-481-7531
Practice Address - Street 1:2446 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1904
Practice Address - Country:US
Practice Address - Phone:708-481-7722
Practice Address - Fax:708-481-7531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK23604Medicare ID - Type Unspecified