Healthcare Provider Details

I. General information

NPI: 1427263128
Provider Name (Legal Business Name): SHELLY MARIE BURNS D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 11/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

733 S WELLS ST
CHICAGO IL
60607-4507
US

IV. Provider business mailing address

1720 S MICHIGAN AVE 1513
CHICAGO IL
60616-1465
US

V. Phone/Fax

Practice location:
  • Phone: 818-419-5995
  • Fax:
Mailing address:
  • Phone: 818-419-5995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038012078
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDC29258
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: