MEDICARE: BURKI CHIROPRACTIC CENTER, INC., PS

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
1	111N00000X	Chiropractor	CH00033768	WA
2	111NR0400X	Rehabilitation Chiropractor	CH00033768	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0156268	OTHER	WA	LABOR & INDUSTRIES

General Provider Information

NPI Number	:	1407045214
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BURKI CHIROPRACTIC CENTER, INC., PS

Provider Business Mailing Address
First Line	:	4423 POINT FOSDICK DR NW
Second Line	:	SUITE 310
City	:	GIG HARBOR
State	:	WA
Zip	:	98335-1797
Country	:	US
Telephone Number	:	253-851-5900
Fax Number	:	253-851-5910

Provider Business Practice Location Address
First Line	:	4423 POINT FOSDICK DR NW
Second Line	:	SUITE 310
City	:	GIG HARBOR
State	:	WA
Zip	:	98335-1797
Country	:	US
Telephone Number	:	253-851-5900
Fax Number	:	253-851-5910

Authorized Official
Title or Position	:	CHIROPRACTOR/PRESIDENT
Name	:	DR. JOHN WALTER BURKI
Credential	:	D.C.
Telephone Number	:	253-851-5900

Provider Enumeration Date	:	10/17/2007
Last Update Date	:	11/26/2007

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