Healthcare Provider Details

I. General information

NPI: 1518481597
Provider Name (Legal Business Name): BURNS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2017
Last Update Date: 08/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 N HIGHWAY 67
FLORISSANT MO
63033-1904
US

IV. Provider business mailing address

12 BATES CT
O FALLON MO
63368-7162
US

V. Phone/Fax

Practice location:
  • Phone: 314-455-4321
  • Fax: 314-455-4321
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. BRAD BURNS
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 314-455-4321