Healthcare Provider Details

I. General information

NPI: 1891139481
Provider Name (Legal Business Name): CHAD EVAN BURKE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2013
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

533 26TH ST STE 100
OGDEN UT
84401-2459
US

IV. Provider business mailing address

533 26TH ST STE 100
OGDEN UT
84401-2459
US

V. Phone/Fax

Practice location:
  • Phone: 801-628-3330
  • Fax:
Mailing address:
  • Phone: 801-628-3330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: