Provider Demographics
NPI:1962589119
Name:BURLEY, CHRISTIAN DONALD (DC, FACO)
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:DONALD
Last Name:BURLEY
Suffix:
Gender:M
Credentials:DC, FACO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 DOGGETT RD
Mailing Address - Street 2:
Mailing Address - City:FOREST CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28043-8203
Mailing Address - Country:US
Mailing Address - Phone:828-245-2442
Mailing Address - Fax:
Practice Address - Street 1:134 ALLENDALE DR
Practice Address - Street 2:
Practice Address - City:FOREST CITY
Practice Address - State:NC
Practice Address - Zip Code:28043-2874
Practice Address - Country:US
Practice Address - Phone:828-245-2442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2037111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0234TOtherBC/BS GROUP NUMBER
NC350048109OtherRAILROAD MEDICARE NUMBER
NC890825BMedicaid
NC0825BOtherBC/BS COSTWISE NUMBER
NC890825BMedicaid