Provider Demographics
NPI:1992852826
Name:BURNS CHIROPRACTIC CLINIC, INC.
Entity Type:Organization
Organization Name:BURNS CHIROPRACTIC CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:K
Authorized Official - Last Name:CARPENTIER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:541-573-3406
Mailing Address - Street 1:102 W MONROE ST
Mailing Address - Street 2:
Mailing Address - City:BURNS
Mailing Address - State:OR
Mailing Address - Zip Code:97720-2107
Mailing Address - Country:US
Mailing Address - Phone:541-573-3406
Mailing Address - Fax:
Practice Address - Street 1:102 W MONROE ST
Practice Address - Street 2:
Practice Address - City:BURNS
Practice Address - State:OR
Practice Address - Zip Code:97720-2107
Practice Address - Country:US
Practice Address - Phone:541-573-3406
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27 2737111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORU21176Medicare UPIN
OR0000QGFQYMedicare ID - Type Unspecified