Provider Demographics
NPI:1184783458
Name:BURSCH, JEREMIAH LUKE (DC)
Entity type:Individual
Prefix:DR
First Name:JEREMIAH
Middle Name:LUKE
Last Name:BURSCH
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 1:12 2ND AVE S
Mailing Address - Street 2:
Mailing Address - City:SAUK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56379-1408
Mailing Address - Country:US
Mailing Address - Phone:320-257-6008
Mailing Address - Fax:320-257-6009
Practice Address - Street 1:12 2ND AVE S
Practice Address - Street 2:
Practice Address - City:SAUK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56379-1408
Practice Address - Country:US
Practice Address - Phone:320-257-6008
Practice Address - Fax:320-257-6009
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4107111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN618536OtherCHIROCARE PROVIDER NUMBER
MN235764000Medicaid
MNP00119927OtherRAILROAD MEDICARE PROVIDE
MN831S1BUOtherBCBS PROVIDER NUMBER
MN235764000Medicaid
MN831S1BUOtherBCBS PROVIDER NUMBER
U86456Medicare UPIN