Healthcare Provider Details

I. General information

NPI: 1710170535
Provider Name (Legal Business Name): JEFFREY ALLEN BURBANK D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2007
Last Update Date: 08/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 N CLARK ST
CARROLL IA
51401-2534
US

IV. Provider business mailing address

715 N CLARK ST
CARROLL IA
51401-2534
US

V. Phone/Fax

Practice location:
  • Phone: 712-792-4600
  • Fax: 712-792-7775
Mailing address:
  • Phone: 712-792-4600
  • Fax: 712-792-7775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number007525
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: