Healthcare Provider Details

I. General information

NPI: 1548619141
Provider Name (Legal Business Name): JORDAN MICHAEL BURNS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2016
Last Update Date: 06/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E 10TH ST
BLOOMINGTON IN
47408-3321
US

IV. Provider business mailing address

110 E 10TH ST
BLOOMINGTON IN
47408-3321
US

V. Phone/Fax

Practice location:
  • Phone: 812-323-0700
  • Fax: 812-323-0702
Mailing address:
  • Phone: 812-323-0700
  • Fax: 812-323-0702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number08002911A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: