Provider Demographics
NPI:1417194192
Name:BURDICK, TANYA LINN (DC)
Entity type:Individual
Prefix:DR
First Name:TANYA
Middle Name:LINN
Last Name:BURDICK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MS
Other - First Name:TANYA
Other - Middle Name:LINN
Other - Last Name:BURDICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5555 N. LAMAR BLVD.
Mailing Address - Street 2:SUITE C121
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78751
Mailing Address - Country:US
Mailing Address - Phone:512-371-1886
Mailing Address - Fax:512-371-1665
Practice Address - Street 1:5555 N. LAMAR BLVD.
Practice Address - Street 2:SUITE C121
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78751
Practice Address - Country:US
Practice Address - Phone:512-371-1886
Practice Address - Fax:512-371-1665
Is Sole Proprietor?:No
Enumeration Date:2009-01-16
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11423111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor