Provider Demographics
NPI:1255353777
Name:BURBANK, TERESA LYNN (DC)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:LYNN
Last Name:BURBANK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:TERESA
Other - Middle Name:LYNN
Other - Last Name:TINDALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1024 ARROWHEAD LN
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:MO
Mailing Address - Zip Code:63084-4555
Mailing Address - Country:US
Mailing Address - Phone:636-579-9080
Mailing Address - Fax:636-584-0790
Practice Address - Street 1:43 PRAIRIE DELL PLZ
Practice Address - Street 2:SUITE 1
Practice Address - City:UNION
Practice Address - State:MO
Practice Address - Zip Code:63084-4341
Practice Address - Country:US
Practice Address - Phone:636-584-0505
Practice Address - Fax:636-584-0790
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006005974111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor