MEDICARE: DR. CHRISTOPHER RYAN BURNHAM D.C., B.S.

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	0104556528	VA
2	111N00000X	Chiropractor	CH10080	FL

General Provider Information

NPI Number	:	1851502306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER RYAN BURNHAM D.C., B.S.

Provider Business Mailing Address
First Line	:	330 N FEDERAL HWY STE 1
Second Line	:
City	:	LAKE PARK
State	:	FL
Zip	:	33403-3531
Country	:	US
Telephone Number	:	561-932-8275
Fax Number	:	561-516-8072

Provider Business Practice Location Address
First Line	:	330 N FEDERAL HWY STE 1
Second Line	:
City	:	LAKE PARK
State	:	FL
Zip	:	33403-3531
Country	:	US
Telephone Number	:	561-932-8275
Fax Number	:	561-516-8072

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

Provider Enumeration Date	:	05/25/2007
Last Update Date	:	01/10/2020

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