Provider Demographics
NPI:1841002649
Name:BURNETT, CHANDLER LANE
Entity type:Individual
Prefix:
First Name:CHANDLER
Middle Name:LANE
Last Name:BURNETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 BLUESTONE CT
Mailing Address - Street 2:
Mailing Address - City:BOILING SPRINGS
Mailing Address - State:SC
Mailing Address - Zip Code:29316-7419
Mailing Address - Country:US
Mailing Address - Phone:856-586-8018
Mailing Address - Fax:
Practice Address - Street 1:817 BLUESTONE CT
Practice Address - Street 2:
Practice Address - City:BOILING SPRINGS
Practice Address - State:SC
Practice Address - Zip Code:29316-7419
Practice Address - Country:US
Practice Address - Phone:864-586-8018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program