MEDICARE: BURNHAM CHIROPRACTIC ENTERPRISES, LLC

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	CH9881	FL

General Provider Information

NPI Number	:	1619390903
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BURNHAM CHIROPRACTIC ENTERPRISES, LLC

Provider Business Mailing Address
First Line	:	461 KINGSLEY AVE
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32073-4827
Country	:	US
Telephone Number	:	904-310-4563
Fax Number	:	904-639-5220

Provider Business Practice Location Address
First Line	:	461 KINGSLEY AVE
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32073-4827
Country	:	US
Telephone Number	:	904-310-4563
Fax Number	:	904-639-5220

Authorized Official
Title or Position	:	OWNER/MANAGING MEMBER
Name	:	DR. JOSEPH M BURNHAM
Credential	:	D.C.
Telephone Number	:	904-803-2982

Provider Enumeration Date	:	01/23/2014
Last Update Date	:	01/23/2014

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