Provider Demographics
NPI:1124438973
Name:THE BURNLEY CLINIC
Entity type:Organization
Organization Name:THE BURNLEY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING AGENET
Authorized Official - Prefix:
Authorized Official - First Name:RAYNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-932-7066
Mailing Address - Street 1:3000 CORPORATE COURT
Mailing Address - Street 2:STE. 100
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-2297
Mailing Address - Country:US
Mailing Address - Phone:214-264-6072
Mailing Address - Fax:877-335-9334
Practice Address - Street 1:3000 CORPORATE CT
Practice Address - Street 2:STE. 100
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-2773
Practice Address - Country:US
Practice Address - Phone:214-264-6072
Practice Address - Fax:877-335-9334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-02
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC11589111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty