Healthcare Provider Details

I. General information

NPI: 1174588719
Provider Name (Legal Business Name): SUSAN PELRINE-BURBANK DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 08/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 EASTMAN ST
SOUTH EASTON MA
02375-1279
US

IV. Provider business mailing address

PO BOX 44
EASTON MA
02334-0044
US

V. Phone/Fax

Practice location:
  • Phone: 508-230-0020
  • Fax: 508-230-0021
Mailing address:
  • Phone: 508-230-0020
  • Fax: 508-230-0021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1934
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: