Provider Demographics
NPI:1952492142
Name:BURGDORF, DAVID MARSHALL (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MARSHALL
Last Name:BURGDORF
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 1:317 LIBBEY INDUSTRIAL PKWY
Mailing Address - Street 2:SUITE B-600
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02189-3113
Mailing Address - Country:US
Mailing Address - Phone:781-337-4400
Mailing Address - Fax:781-337-4480
Practice Address - Street 1:317 LIBBEY INDUSTRIAL PKWY
Practice Address - Street 2:SUITE B-600
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02189-3113
Practice Address - Country:US
Practice Address - Phone:781-337-4400
Practice Address - Fax:781-337-4480
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1612111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY36172Medicare ID - Type Unspecified