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General NPI Number Information
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NPI Number | 1770668550
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Entity Type | Organization
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Legal Business Name | MICHAEL S BURGOON DC PC
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Dates
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Enumeration Date | 10/27/2006
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Last Update Date | 07/28/2010
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Provider Practice Location Address
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Address Line | 2302 COLONIAL AVE SW SUITE A
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City | ROANOKE
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State | VA
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Zip | 24015
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Country | US
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Telephone | 540-343-6636
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Fax | 540-343-6670
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Provider Business Mailing Address
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Address Line | 2302 COLONIAL AVE SW SUITE A
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City | ROANOKE
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State | VA
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Zip | 24015
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Country | US
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Telephone | 540-343-6636
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Fax | 540-343-6670
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Authorized Official
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Title or Position | PRESIDENT CEO OF CORPORATION
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Name | MICHAEL S BURGOON
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Credential | DC
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Telephone | 540-343-6636
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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 | 0104001967
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License Number State | VA
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