Provider Demographics
NPI:1740827682
Name:BURNS, PETER
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:BURNS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5307 ARGYLE WAY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-5812
Mailing Address - Country:US
Mailing Address - Phone:463-265-8591
Mailing Address - Fax:
Practice Address - Street 1:7300 BLANCO RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-4936
Practice Address - Country:US
Practice Address - Phone:210-977-0070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-10
Last Update Date:2020-02-04
Deactivation Date:2019-12-17
Deactivation Code:
Reactivation Date:2020-02-04
Provider Licenses
StateLicense IDTaxonomies
TX14166111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor