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General NPI Number Information
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NPI Number | 1740348143
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Entity Type | Organization
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Legal Business Name | SILVER STATE SPINECARE FORREST BURKE MD A PROFESSIONAL CORP
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 08/07/2013
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Provider Practice Location Address
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Address Line | 1055 ROBERTA LN 103
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City | SPARKS
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State | NV
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Zip | 89431-1893
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Country | US
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Telephone | 775-331-2600
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Fax | 775-331-2605
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Provider Business Mailing Address
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Address Line | 1055 ROBERTA LN 103
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City | SPARKS
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State | NV
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Zip | 89431-1893
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Country | US
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Telephone | 775-331-2600
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Fax | 775-331-2605
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Authorized Official
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Title or Position | OWNER
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Name | BRIAN FORREST BURKE
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Credential | MD
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Telephone | 775-331-2600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 8968
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License Number State | NV
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