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General NPI Number Information
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NPI Number | 1710091939
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Entity Type | Organization
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Legal Business Name | LAURIE C. BURKE, DOCTOR OF CHIROPRACTIC P.C.
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Dates
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Enumeration Date | 08/17/2006
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Last Update Date | 07/10/2008
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Provider Practice Location Address
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Address Line | 242 CLARKSON RD
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City | ELLISVILLE
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State | MO
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Zip | 63011-2245
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Country | US
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Telephone | 636-227-8191
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Fax |
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Provider Business Mailing Address
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Address Line | 242 CLARKSON RD
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City | ELLISVILLE
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State | MO
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Zip | 63011-2245
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Country | US
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Telephone | 636-227-8191
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. LAURIE BURKE
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Credential | D.C.
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Telephone | 636-227-8191
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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 | 004760
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License Number State | MO
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