Provider Demographics
NPI:1780768200
Name:BURKHARDT, CHRISTINA (DC)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:BURKHARDT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:BURKHARDT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:25400 ALESSANDRO BLVD
Mailing Address - Street 2:102
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-4319
Mailing Address - Country:US
Mailing Address - Phone:951-247-4292
Mailing Address - Fax:
Practice Address - Street 1:25400 ALESSANDRO BLVD
Practice Address - Street 2:102
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-4319
Practice Address - Country:US
Practice Address - Phone:951-247-4292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17040111N00000X
OR282194111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor