Provider Demographics
NPI:1215235080
Name:BURNS CHIROPRACTIC
Entity type:Organization
Organization Name:BURNS CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-271-7123
Mailing Address - Street 1:308 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:AUDUBON
Mailing Address - State:IA
Mailing Address - Zip Code:50025-1104
Mailing Address - Country:US
Mailing Address - Phone:563-271-7123
Mailing Address - Fax:
Practice Address - Street 1:308 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:AUDUBON
Practice Address - State:IA
Practice Address - Zip Code:50025-1104
Practice Address - Country:US
Practice Address - Phone:563-271-7123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007215111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA11993141OtherCAQH PROVIDER ID