Provider Demographics
NPI:1720263718
Name:BURGESS, JAMES LYNN (DC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:LYNN
Last Name:BURGESS
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 1:150 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84015-1045
Mailing Address - Country:US
Mailing Address - Phone:801-825-0134
Mailing Address - Fax:801-773-1247
Practice Address - Street 1:150 S STATE ST
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:UT
Practice Address - Zip Code:84015-1045
Practice Address - Country:US
Practice Address - Phone:801-825-0134
Practice Address - Fax:801-773-1247
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-08
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT320245-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
261701971OtherTAX ID