Provider Demographics
NPI:1922052893
Name:BURKE, DOUGLAS W (DC)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:W
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 1:170 BABCOCK RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78201-3806
Mailing Address - Country:US
Mailing Address - Phone:210-340-9944
Mailing Address - Fax:210-340-9950
Practice Address - Street 1:170 BABCOCK RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78201-3806
Practice Address - Country:US
Practice Address - Phone:210-340-9944
Practice Address - Fax:210-340-9950
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC7096111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8R3190OtherBCBS
TX8X1800OtherBC/BS
T60517Medicare UPIN