Provider Demographics
NPI:1134202005
Name:BURSTEIN, ILAN (DC)
Entity type:Individual
Prefix:DR
First Name:ILAN
Middle Name:
Last Name:BURSTEIN
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 1:6 WISHING WELL LN
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-1631
Mailing Address - Country:US
Mailing Address - Phone:203-325-8112
Mailing Address - Fax:203-388-8021
Practice Address - Street 1:6 WISHING WELL LN
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-1631
Practice Address - Country:US
Practice Address - Phone:203-325-8112
Practice Address - Fax:203-388-8021
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000431111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0431OtherLICENSE #