Provider Demographics
NPI:1740264076
Name:BURKETT, JOEL H (DC)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:H
Last Name:BURKETT
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 1:700 FREEPORT RD
Mailing Address - Street 2:
Mailing Address - City:BRACKENRIDGE
Mailing Address - State:PA
Mailing Address - Zip Code:15014
Mailing Address - Country:US
Mailing Address - Phone:724-224-3111
Mailing Address - Fax:724-224-9078
Practice Address - Street 1:700 FREEPORT RD
Practice Address - Street 2:
Practice Address - City:BRACKENRIDGE
Practice Address - State:PA
Practice Address - Zip Code:15014
Practice Address - Country:US
Practice Address - Phone:724-224-3111
Practice Address - Fax:724-224-9078
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001597L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT29963Medicare UPIN
PA179685Medicare ID - Type Unspecified