Provider Demographics
NPI:1215922141
Name:BURSON, DOUGLAS S (DC)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:S
Last Name:BURSON
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 1:5445 DTC PKWY STE 1130
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-3038
Mailing Address - Country:US
Mailing Address - Phone:720-749-5599
Mailing Address - Fax:720-925-5897
Practice Address - Street 1:520 ZANG ST STE 250
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80021-8347
Practice Address - Country:US
Practice Address - Phone:303-214-7907
Practice Address - Fax:720-925-5897
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-16
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3617012111N00000X
COCHR.0006980111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38933100Medicaid
U89164Medicare UPIN