Provider Demographics
NPI:1841323326
Name:BURKE SPINAL CARE, LTD
Entity type:Organization
Organization Name:BURKE SPINAL CARE, LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CAMERON
Authorized Official - Middle Name:MITCHELL
Authorized Official - Last Name:DUDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:702-453-0440
Mailing Address - Street 1:7240 W LAKE MEAD BLVD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-8356
Mailing Address - Country:US
Mailing Address - Phone:702-453-0440
Mailing Address - Fax:702-453-0550
Practice Address - Street 1:7240 W LAKE MEAD BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-8356
Practice Address - Country:US
Practice Address - Phone:702-453-0440
Practice Address - Fax:702-453-0550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB00447111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV3602060Medicaid
NV3602060Medicaid
NVVWJBCX02Medicare PIN
NVU23772Medicare UPIN