Provider Demographics
NPI:1780785089
Name:BURKHARDT, CYNTHIA (DC)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:
Last Name:BURKHARDT
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 1:11274 LOS ALAMITOS BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3958
Mailing Address - Country:US
Mailing Address - Phone:562-598-2923
Mailing Address - Fax:562-431-3263
Practice Address - Street 1:11274 LOS ALAMITOS BLVD
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3958
Practice Address - Country:US
Practice Address - Phone:562-598-2923
Practice Address - Fax:562-431-3263
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21648111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC21648Medicare ID - Type UnspecifiedCYNTHIA BURKHARDT, D.C.