Provider Demographics
NPI:1285753921
Name:BURKS, MATTHEW A (DC)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:A
Last Name:BURKS
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 1:406 JUNGERMANN RD
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-2764
Mailing Address - Country:US
Mailing Address - Phone:636-395-2852
Mailing Address - Fax:636-244-1219
Practice Address - Street 1:406 JUNGERMANN RD
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-2764
Practice Address - Country:US
Practice Address - Phone:636-395-2852
Practice Address - Fax:636-244-1219
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012969111N00000X
MO2021013227111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1427093566OtherNPI
CAWDC26537AMedicare PIN