Provider Demographics
NPI:1295747558
Name:JULIE ANN BURKE
Entity type:Organization
Organization Name:JULIE ANN BURKE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:617-964-3332
Mailing Address - Street 1:383 ELLIOT ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:NEWTON UPPER FALLS
Mailing Address - State:MA
Mailing Address - Zip Code:02464-1126
Mailing Address - Country:US
Mailing Address - Phone:617-964-3332
Mailing Address - Fax:617-332-7601
Practice Address - Street 1:383 ELLIOT ST
Practice Address - Street 2:SUITE 250
Practice Address - City:NEWTON UPPER FALLS
Practice Address - State:MA
Practice Address - Zip Code:02464-1126
Practice Address - Country:US
Practice Address - Phone:617-964-3332
Practice Address - Fax:617-332-7601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA115111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY39460OtherBLUECROSS BLUESHIELD
MAY39460OtherBLUECROSS BLUESHIELD