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General NPI Number Information
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NPI Number | 1780734434
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Entity Type | Organization
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Legal Business Name | BURDETTE FAMILY CHIROPRACTIC AND WELLNESS CENTER, INC.
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 307 CLEVELAND AVE.
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City | FAIRMONT
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State | WV
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Zip | 26554
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Country | US
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Telephone | 304-363-4006
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Fax | 304-363-4008
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Provider Business Mailing Address
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Address Line | 307 CLEVELAND AVE.
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City | FAIRMONT
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State | WV
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Zip | 26554
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Country | US
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Telephone | 304-363-4006
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Fax | 304-363-4008
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LAWRENCE WILSON BURDETTE III
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Credential | D.C.
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Telephone | 304-363-4006
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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 | 800
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License Number State | WV
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