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General NPI Number Information
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NPI Number | 1144735242
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Entity Type | Individual
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Provider Name | BRENTON BURCHETT DC
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Gender | Male
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Dates
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Enumeration Date | 12/11/2017
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Last Update Date | 12/11/2017
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Provider Practice Location Address
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Address Line | 5701 GEORGE WASHINGTON MEM HWY
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City | YORKTOWN
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State | VA
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Zip | 23692-2773
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Country | US
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Telephone | 757-874-5666
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Fax |
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Provider Business Mailing Address
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Address Line | 2645 GREEN FARM RD
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City | DANVILLE
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State | VA
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Zip | 24540-0211
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Country | US
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Telephone | 434-607-2406
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 0104557454
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License Number State | VA
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