MEDICARE: AUTUMN BURNS DC

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	111NR0400X	Rehabilitation Chiropractor	14031	FL

General Provider Information

NPI Number	:	1871239855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUTUMN BURNS DC

Provider Business Mailing Address
First Line	:	703 PRUITT DR
Second Line	:
City	:	MADEIRA BEACH
State	:	FL
Zip	:	33708-2358
Country	:	US
Telephone Number	:	330-464-1272
Fax Number	:

Provider Business Practice Location Address
First Line	:	6250 PARK BLVD N
Second Line	:
City	:	PINELLAS PARK
State	:	FL
Zip	:	33781-3237
Country	:	US
Telephone Number	:	727-541-2520
Fax Number	:

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

Provider Enumeration Date	:	05/11/2022
Last Update Date	:	05/11/2022

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