Provider Demographics
NPI:1932711066
Name:BURDGE, LEE ANN (DC)
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:ANN
Last Name:BURDGE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16505 82ND PL NE
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:WA
Mailing Address - Zip Code:98028-4470
Mailing Address - Country:US
Mailing Address - Phone:813-451-7731
Mailing Address - Fax:
Practice Address - Street 1:6016 NE BOTHELL WAY STE B
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:WA
Practice Address - Zip Code:98028-9403
Practice Address - Country:US
Practice Address - Phone:425-486-2844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002990111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor