Provider Demographics
NPI:1720226517
Name:BURNETT, MICHAEL (LAC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:BURNETT
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 GLEN HILL RD
Mailing Address - Street 2:C/O WINDHORSE ACUPUNCTURE
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06811-4906
Mailing Address - Country:US
Mailing Address - Phone:203-792-9463
Mailing Address - Fax:
Practice Address - Street 1:2 GLEN HILL RD
Practice Address - Street 2:C/O WINDHORSE ACUPUNCTURE
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06811-4906
Practice Address - Country:US
Practice Address - Phone:203-792-9463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-02
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000382171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist