=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083983753
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CRAIG M BURNS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/23/2011
-----------------------------------------------------
Last Update Date | 12/23/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15655 NE 85TH STREET SUITE 3
-----------------------------------------------------
City | REDMOND
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98052-3563
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-881-3100
-----------------------------------------------------
Fax | 425-881-3102
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15655 NE 85TH ST STE 3
-----------------------------------------------------
City | REDMOND
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98052-3563
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-881-3100
-----------------------------------------------------
Fax | 425-881-3102
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. CRAIG MATTHEW BURNS
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 425-233-9059
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH00034573
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------