Provider Demographics
NPI:1104052711
Name:BURNS, BRADLEY EDWARD (DC)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:EDWARD
Last Name:BURNS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 N HIGHWAY 67
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-1904
Mailing Address - Country:US
Mailing Address - Phone:314-455-4321
Mailing Address - Fax:314-455-4321
Practice Address - Street 1:6210 LANGDON CT
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:MO
Practice Address - Zip Code:63134-1606
Practice Address - Country:US
Practice Address - Phone:314-949-1422
Practice Address - Fax:314-788-3415
Is Sole Proprietor?:No
Enumeration Date:2009-06-09
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011039659111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor