Healthcare Provider Details

I. General information

NPI: 1841413705
Provider Name (Legal Business Name): GREGORY JON BURMEISTER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 W BROADWAY ST
EAGLE GROVE IA
50533-1712
US

IV. Provider business mailing address

316 S WESTERN AVE
EAGLE GROVE IA
50533-2027
US

V. Phone/Fax

Practice location:
  • Phone: 515-448-3387
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberAO5314
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: