Provider Demographics
NPI:1386709806
Name:BURKE, TERRY LYNN (DC, NMD)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:LYNN
Last Name:BURKE
Suffix:
Gender:M
Credentials:DC, NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1348 E 17TH ST
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-6270
Mailing Address - Country:US
Mailing Address - Phone:208-542-6564
Mailing Address - Fax:208-542-6571
Practice Address - Street 1:1348 E 17TH ST
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-6270
Practice Address - Country:US
Practice Address - Phone:208-542-6564
Practice Address - Fax:208-542-6571
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDC792111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1740281435OtherINC NPI
ID1740281435OtherINC NPI