Provider Demographics
NPI:1780714972
Name:BURR, MARTIN E (DC)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:E
Last Name:BURR
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 1:15840 VENTURA BLVD
Mailing Address - Street 2:SUITE # 302
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2932
Mailing Address - Country:US
Mailing Address - Phone:818-728-0740
Mailing Address - Fax:818-385-1945
Practice Address - Street 1:15840 VENTURA BLVD
Practice Address - Street 2:SUITE # 302
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2932
Practice Address - Country:US
Practice Address - Phone:818-728-0740
Practice Address - Fax:818-385-1945
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27020111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC27020Medicare ID - Type Unspecified