Provider Demographics
NPI:1255360756
Name:BURNETT, ALECIA (DC)
Entity type:Individual
Prefix:
First Name:ALECIA
Middle Name:
Last Name:BURNETT
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 1:4645 E BROADWAY RD
Mailing Address - Street 2:SUITE #105
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85040-8879
Mailing Address - Country:US
Mailing Address - Phone:602-431-6003
Mailing Address - Fax:602-431-6009
Practice Address - Street 1:4645 E BROADWAY RD
Practice Address - Street 2:SUITE #105
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85040-8879
Practice Address - Country:US
Practice Address - Phone:602-431-6003
Practice Address - Fax:602-431-6009
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7566111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor