Provider Demographics
NPI:1932768967
Name:TEDRA BURKE-SEARLS CHIROPRACTIC PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:TEDRA BURKE-SEARLS CHIROPRACTIC PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TEDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKE-SEARLS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-715-6366
Mailing Address - Street 1:1348 E 17TH ST
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-6270
Mailing Address - Country:US
Mailing Address - Phone:208-715-6366
Mailing Address - Fax:208-715-6111
Practice Address - Street 1:1348 E 17TH ST
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-6270
Practice Address - Country:US
Practice Address - Phone:208-715-6366
Practice Address - Fax:208-715-6111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-12
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty