Provider Demographics
NPI:1396801429
Name:DAVID BURROUGHS PC
Entity type:Organization
Organization Name:DAVID BURROUGHS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:BURROUGHS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:830-980-7520
Mailing Address - Street 1:28120 US HIGHWAY 281 N
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78260-1708
Mailing Address - Country:US
Mailing Address - Phone:830-980-7520
Mailing Address - Fax:830-438-7739
Practice Address - Street 1:28120 US HIGHWAY 281 N
Practice Address - Street 2:SUITE 104
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78260-1708
Practice Address - Country:US
Practice Address - Phone:830-980-7520
Practice Address - Fax:830-438-7739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-01
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7226111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB115085OtherGROUP PTAN