Provider Demographics
NPI:1336189224
Name:BURKE, TERRY LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:LEE
Last Name:BURKE
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 1:102 23RD AVE SW
Mailing Address - Street 2:APT F-102
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-7527
Mailing Address - Country:US
Mailing Address - Phone:210-846-8973
Mailing Address - Fax:
Practice Address - Street 1:102 23RD AVE SW
Practice Address - Street 2:APT F-102
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-7527
Practice Address - Country:US
Practice Address - Phone:210-846-8973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5141111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor