Healthcare Provider Details

I. General information

NPI: 1083687545
Provider Name (Legal Business Name): CHAD WILLIAM BURT D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 N MAIN ST
WALCOTT IA
52773-9505
US

IV. Provider business mailing address

PO BOX 790
WALCOTT IA
52773-0790
US

V. Phone/Fax

Practice location:
  • Phone: 563-284-6927
  • Fax: 563-284-6398
Mailing address:
  • Phone: 563-284-6927
  • Fax: 563-284-6398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number06404
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: