Provider Demographics
NPI:1972598175
Name:BURLE, JEAN M (DC)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:M
Last Name:BURLE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63383-2007
Mailing Address - Country:US
Mailing Address - Phone:636-456-4091
Mailing Address - Fax:
Practice Address - Street 1:307 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:MO
Practice Address - Zip Code:63383-2007
Practice Address - Country:US
Practice Address - Phone:636-456-4091
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006442111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition