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General NPI Number Information
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NPI Number | 1497986186
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Entity Type | Organization
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Legal Business Name | BURDOCK FAMILY CHIROPRATIC PC
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Dates
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Enumeration Date | 07/29/2009
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Last Update Date | 07/29/2009
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Provider Practice Location Address
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Address Line | 208 S MARION AVE
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City | WASHINGTON
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State | IA
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Zip | 52353-1744
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Country | US
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Telephone | 319-653-3573
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Fax | 319-653-3573
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Provider Business Mailing Address
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Address Line | 208 S MARION AVE
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City | WASHINGTON
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State | IA
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Zip | 52353-1744
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Country | US
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Telephone | 319-653-3573
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Fax | 319-653-3573
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EDWARD M BURDOCK
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Credential | DC
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Telephone | 319-653-3573
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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 | A06120
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License Number State | IA
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