Provider Demographics
NPI:1801974837
Name:BURKE MAYS P.A.
Entity type:Organization
Organization Name:BURKE MAYS P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BURKE
Authorized Official - Middle Name:RAFER
Authorized Official - Last Name:MAYS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:612-242-0045
Mailing Address - Street 1:6200 EXCELSIOR BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-2730
Mailing Address - Country:US
Mailing Address - Phone:952-925-4639
Mailing Address - Fax:952-925-2404
Practice Address - Street 1:6200 EXCELSIOR BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-2730
Practice Address - Country:US
Practice Address - Phone:952-925-4639
Practice Address - Fax:952-925-2404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3502111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN476M4CHOtherBLUE CROSS/BLUE SHIELD
MN428717700Medicaid
MNU66545Medicare UPIN
MN476M4CHOtherBLUE CROSS/BLUE SHIELD