Healthcare Provider Details

I. General information

NPI: 1700716115
Provider Name (Legal Business Name): CHRISTIAN J BURKS MS, CHW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 175TH ST
HAZEL CREST IL
60429-1705
US

IV. Provider business mailing address

3813 EDGEWATER DR
HAZEL CREST IL
60429-2438
US

V. Phone/Fax

Practice location:
  • Phone: 312-463-9440
  • Fax:
Mailing address:
  • Phone: 312-463-9440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberHVM74423
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: