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General NPI Number Information
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NPI Number | 1427263128
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Entity Type | Individual
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Provider Name | SHELLY MARIE BURNS D.C.
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Gender | Female
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 11/22/2011
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Provider Practice Location Address
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Address Line | 733 S WELLS ST
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City | CHICAGO
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State | IL
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Zip | 60607-4507
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Country | US
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Telephone | 818-419-5995
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Fax |
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Provider Business Mailing Address
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Address Line | 1720 S MICHIGAN AVE 1513
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City | CHICAGO
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State | IL
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Zip | 60616-1465
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Country | US
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Telephone | 818-419-5995
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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 | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | DC29258
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 038012078
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License Number State | IL
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