Provider Demographics
NPI:1366415952
Name:BURNS, JENNIFER JUDITH (DC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JUDITH
Last Name:BURNS
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 1:3636 MENAUL BLVD NE
Mailing Address - Street 2:SUITE 307
Mailing Address - City:ALB
Mailing Address - State:NM
Mailing Address - Zip Code:87110
Mailing Address - Country:US
Mailing Address - Phone:505-883-5443
Mailing Address - Fax:
Practice Address - Street 1:3636 MENAUL BLVD NE SUITE 307
Practice Address - Street 2:
Practice Address - City:ALB
Practice Address - State:NM
Practice Address - Zip Code:87110
Practice Address - Country:US
Practice Address - Phone:505-883-5443
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1272111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor