Provider Demographics
NPI:1851443907
Name:BURLISON, DENNIS LEE (DC)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:LEE
Last Name:BURLISON
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:PO BOX 216
Mailing Address - Street 2:
Mailing Address - City:MEHAMA
Mailing Address - State:OR
Mailing Address - Zip Code:97384-0216
Mailing Address - Country:US
Mailing Address - Phone:503-859-2181
Mailing Address - Fax:503-859-3818
Practice Address - Street 1:11247 GROVE ST SE
Practice Address - Street 2:
Practice Address - City:MEHAMA
Practice Address - State:OR
Practice Address - Zip Code:97384
Practice Address - Country:US
Practice Address - Phone:503-859-2181
Practice Address - Fax:503-859-3818
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27-2457111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR075218Medicaid
ORR00002QGFFXMedicare PIN
OR075218Medicaid