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General NPI Number Information
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NPI Number | 1740281435
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Entity Type | Organization
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Legal Business Name | BURKE FAMILY CHIROPRACTIC INTEGRATIVE HEALTH SERVICES, INC.
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Dates
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Enumeration Date | 08/03/2005
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Last Update Date | 10/29/2012
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Provider Practice Location Address
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Address Line | 1348 E 17TH ST
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City | IDAHO FALLS
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State | ID
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Zip | 83404-6270
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Country | US
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Telephone | 208-542-6564
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Fax | 208-542-6571
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Provider Business Mailing Address
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Address Line | 1348 E 17TH ST
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City | IDAHO FALLS
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State | ID
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Zip | 83404-6270
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Country | US
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Telephone | 208-542-6564
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Fax | 208-542-6571
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TERRY LYNN BURKE
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Credential | D.C.
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Telephone | 208-542-6564
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NX0800X
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Taxonomy Name | Orthopedic Chiropractor
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License Number | CHIA-792
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License Number State | ID
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