Healthcare Provider Details

I. General information

NPI: 1487582292
Provider Name (Legal Business Name): JAMES BURCH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5924 CLEVELAND AVE
STEVENSVILLE MI
49127-9482
US

IV. Provider business mailing address

460 YELLOW CREEK DR
SAINT JOSEPH MI
49085-9378
US

V. Phone/Fax

Practice location:
  • Phone: 269-925-5225
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7501017309
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: