MEDICARE: DR. MATTHEW D BURNETT N.D. 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	175F00000X	Naturopath	5686708-7100	UT

General Provider Information

NPI Number	:	1669527271
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW D BURNETT N.D. LAC.

Provider Business Mailing Address
First Line	:	423 F ST
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84103-2838
Country	:	US
Telephone Number	:	801-363-8824
Fax Number	:

Provider Business Practice Location Address
First Line	:	989 E 900 S STE A1
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-1452
Country	:	US
Telephone Number	:	801-363-8824
Fax Number	:

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

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	07/08/2007

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