Provider Demographics
NPI:1104909852
Name:BURROUGHS, DAVID W (DC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:W
Last Name:BURROUGHS
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 1:28120 US HIGHWAY 281 N
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78260-1708
Mailing Address - Country:US
Mailing Address - Phone:830-980-7520
Mailing Address - Fax:830-438-7739
Practice Address - Street 1:28120 US HIGHWAY 281 N
Practice Address - Street 2:SUITE 104
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78260-1708
Practice Address - Country:US
Practice Address - Phone:830-980-7520
Practice Address - Fax:830-438-7739
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7226111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB115086OtherINDIVIDUAL PTAN
TXTXB115086OtherINDIVIDUAL PTAN