Healthcare Provider Details

I. General information

NPI: 1871585844
Provider Name (Legal Business Name): KATIE JEANNINE BURMEISTER D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 01/12/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 S DELMAR AVE STE B
SALEM IL
62881-2000
US

IV. Provider business mailing address

PO BOX 86
SALEM IL
62881-0086
US

V. Phone/Fax

Practice location:
  • Phone: 618-401-7117
  • Fax: 618-662-4830
Mailing address:
  • Phone: 618-740-1711
  • Fax: 618-662-4830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038009763
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: