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NPI Code Detail

MEDICARE: DR. BRADLEY EDWARD BURNS D.C

MEDICARE: DR. BRADLEY EDWARD BURNS D.C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractor2011039659MO

General Provider Information

NPI Number : 1104052711
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRADLEY EDWARD BURNS D.C
Provider Business Mailing Address
First Line : 1930 N HIGHWAY 67
Second Line :
City : FLORISSANT
State : MO
Zip : 63033-1904
Country : US
Telephone Number : 314-455-4321
Fax Number : 314-455-4321
Provider Business Practice Location Address
First Line : 6210 LANGDON CT
Second Line :
City : BERKELEY
State : MO
Zip : 63134-1606
Country : US
Telephone Number : 314-949-1422
Fax Number : 314-788-3415
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2009
Last Update Date : 07/26/2024

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