Healthcare Provider Details

I. General information

NPI: 1609350008
Provider Name (Legal Business Name): JOSEPH ROCCO BURDI DC, LAT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2018
Last Update Date: 05/19/2022
Certification Date: 05/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3413 SULLIVAN TRL
EASTON PA
18040-7642
US

IV. Provider business mailing address

3413 SULLIVAN TRL
EASTON PA
18040-7642
US

V. Phone/Fax

Practice location:
  • Phone: 610-438-2015
  • Fax:
Mailing address:
  • Phone: 610-438-2015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC011385
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: