Provider Demographics
NPI:1316502909
Name:BURKE STREET CHIROPRACTIC, PLLC
Entity type:Organization
Organization Name:BURKE STREET CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:SHARP
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:336-768-7227
Mailing Address - Street 1:4622 COUNTRY CLUB RD - STE 140
Mailing Address - Street 2:
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104
Mailing Address - Country:US
Mailing Address - Phone:336-768-7227
Mailing Address - Fax:336-768-3802
Practice Address - Street 1:1016 BURKE ST.
Practice Address - Street 2:
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101
Practice Address - Country:US
Practice Address - Phone:336-281-2161
Practice Address - Fax:636-795-1500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-08
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty