Healthcare Provider Details

I. General information

NPI: 1528229218
Provider Name (Legal Business Name): RICHARD WARD BURG D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 12/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6330 TELEGRAPH AVE
OAKLAND CA
94609-1329
US

IV. Provider business mailing address

6330 TELEGRAPH AVE
OAKLAND CA
94609-1329
US

V. Phone/Fax

Practice location:
  • Phone: 510-601-6330
  • Fax: 510-601-6331
Mailing address:
  • Phone: 510-601-6330
  • Fax: 510-601-6331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberDC-30950
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: