Healthcare Provider Details

I. General information

NPI: 1649279977
Provider Name (Legal Business Name): JENNIFER L BURGESS DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 10/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 S OAK ST
MOUNT CARMEL PA
17851-2145
US

IV. Provider business mailing address

107 S OAK ST
MOUNT CARMEL PA
17851-2145
US

V. Phone/Fax

Practice location:
  • Phone: 570-339-4599
  • Fax: 866-876-8987
Mailing address:
  • Phone: 570-339-4599
  • Fax: 866-876-8987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number007320-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: