Healthcare Provider Details

I. General information

NPI: 1437463361
Provider Name (Legal Business Name): EUGENE ARTHUR BURCH II D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: GENO BURCH D.C.

II. Dates (important events)

Enumeration Date: 08/03/2010
Last Update Date: 08/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5041 DALLAS HWY SUITE 500
POWDER SPRINGS GA
30127-6458
US

IV. Provider business mailing address

1806 AUGUSTA DR SE
MARIETTA GA
30067-8213
US

V. Phone/Fax

Practice location:
  • Phone: 770-919-7171
  • Fax: 770-218-0341
Mailing address:
  • Phone: 678-315-8679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR008694
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: