Healthcare Provider Details

I. General information

NPI: 1104052711
Provider Name (Legal Business Name): BRADLEY EDWARD BURNS D.C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2009
Last Update Date: 07/26/2024
Certification Date: 07/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6210 LANGDON CT
BERKELEY MO
63134-1606
US

IV. Provider business mailing address

1930 N HIGHWAY 67
FLORISSANT MO
63033-1904
US

V. Phone/Fax

Practice location:
  • Phone: 314-949-1422
  • Fax: 314-788-3415
Mailing address:
  • Phone: 314-455-4321
  • Fax: 314-455-4321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2011039659
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: