Provider Demographics
NPI:1770951451
Name:BURSE, FELICIA (DC)
Entity type:Individual
Prefix:
First Name:FELICIA
Middle Name:
Last Name:BURSE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 MACKINAW AVE APT 1C
Mailing Address - Street 2:
Mailing Address - City:CALUMET CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60409-5724
Mailing Address - Country:US
Mailing Address - Phone:773-972-9038
Mailing Address - Fax:
Practice Address - Street 1:1224 MACKINAW AVE APT 1C
Practice Address - Street 2:
Practice Address - City:CALUMET CITY
Practice Address - State:IL
Practice Address - Zip Code:60409-5724
Practice Address - Country:US
Practice Address - Phone:773-972-9038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-11
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.012292111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor