Provider Demographics
NPI:1457387672
Name:BURCHARD, LARRY JASON (DC)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:JASON
Last Name:BURCHARD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:L.
Other - Middle Name:JASON
Other - Last Name:BURCHARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:818 E CLARK BLVD
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-2324
Mailing Address - Country:US
Mailing Address - Phone:615-895-2800
Mailing Address - Fax:615-895-2860
Practice Address - Street 1:818 E CLARK BLVD
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-2324
Practice Address - Country:US
Practice Address - Phone:615-895-2800
Practice Address - Fax:615-895-2860
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2028111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3973475Medicare ID - Type Unspecified
TNV04993Medicare UPIN