Provider Demographics
NPI:1679775522
Name:BURNS CHIROPRACTIC, PA
Entity type:Organization
Organization Name:BURNS CHIROPRACTIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TREVON
Authorized Official - Middle Name:TRENT
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:620-855-7253
Mailing Address - Street 1:19307 EAST U.S. HIGHWAY 50
Mailing Address - Street 2:P.O. BOX 1031
Mailing Address - City:CIMARRON
Mailing Address - State:KS
Mailing Address - Zip Code:67835-1031
Mailing Address - Country:US
Mailing Address - Phone:620-855-7253
Mailing Address - Fax:620-855-7253
Practice Address - Street 1:19307 EAST U.S. HIGHWAY 50
Practice Address - Street 2:
Practice Address - City:CIMARRON
Practice Address - State:KS
Practice Address - Zip Code:67835-1031
Practice Address - Country:US
Practice Address - Phone:620-855-7253
Practice Address - Fax:620-855-7253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-04611111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS660134Medicare ID - Type Unspecified