Provider Demographics
NPI:1154531457
Name:BURELSON, AMY LEE (DC)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:LEE
Last Name:BURELSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:569 COLUMBIA TPKE
Mailing Address - Street 2:
Mailing Address - City:EAST GREENBUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12061-1601
Mailing Address - Country:US
Mailing Address - Phone:518-477-5000
Mailing Address - Fax:518-477-5009
Practice Address - Street 1:569 COLUMBIA TPKE
Practice Address - Street 2:
Practice Address - City:EAST GREENBUSH
Practice Address - State:NY
Practice Address - Zip Code:12061-1601
Practice Address - Country:US
Practice Address - Phone:518-477-5000
Practice Address - Fax:518-477-5009
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009854-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDD0612Medicare ID - Type Unspecified
U85571Medicare UPIN