Provider Demographics
NPI:1396744462
Name:BURKHOLDER, DEAN RALPH (DC)
Entity type:Individual
Prefix:
First Name:DEAN
Middle Name:RALPH
Last Name:BURKHOLDER
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 1:9318 MOLLY PITCHER HWY
Mailing Address - Street 2:
Mailing Address - City:SHIPPENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17257-9205
Mailing Address - Country:US
Mailing Address - Phone:717-532-8873
Mailing Address - Fax:717-532-3845
Practice Address - Street 1:9318 MOLLY PITCHER HWY
Practice Address - Street 2:
Practice Address - City:SHIPPENSBURG
Practice Address - State:PA
Practice Address - Zip Code:17257-9205
Practice Address - Country:US
Practice Address - Phone:717-532-8873
Practice Address - Fax:717-532-3845
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001937L111N00000X
PADC001937L, CERT #73111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
287165OtherMAMSI
PA0006213800003Medicaid
555345OtherAETNA
287165OtherMAMSI