Provider Demographics
NPI:1992866925
Name:BURNS, THERESA L (DC)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:L
Last Name:BURNS
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 1:692 W SCHUYLKILL RD
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19465-7430
Mailing Address - Country:US
Mailing Address - Phone:484-624-3726
Mailing Address - Fax:484-949-8495
Practice Address - Street 1:692 W SCHUYLKILL RD
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19465-7430
Practice Address - Country:US
Practice Address - Phone:484-624-3726
Practice Address - Fax:484-949-8495
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-007487-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA27152Medicare ID - Type Unspecified