MEDICARE: MR. CHRIS BURTON LAC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1417575416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHRIS BURTON LAC

Provider Business Mailing Address
First Line	:	1017 3RD ST
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47201-6870
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1017 3RD ST
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47201-6870
Country	:	US
Telephone Number	:	812-558-0574
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2020
Last Update Date	:	07/07/2020

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