Healthcare Provider Details

I. General information

NPI: 1629263009
Provider Name (Legal Business Name): JOHN LONERGAN BURKE JR. N.D.,LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JACK BURKE N.D.,LAC

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 09/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41-044 ALOILOI ST
WAIMANALO HI
96795-1622
US

IV. Provider business mailing address

41-044 ALOILOI ST
WAIMANALO HI
96795-1622
US

V. Phone/Fax

Practice location:
  • Phone: 808-259-6889
  • Fax:
Mailing address:
  • Phone: 808-259-6889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number159
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number72
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: