Provider Demographics
NPI:1992790943
Name:BURKHART, KEVIN M (DC)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:M
Last Name:BURKHART
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 1:515 E DIVISION ST STE 125
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-1378
Mailing Address - Country:US
Mailing Address - Phone:616-863-1020
Mailing Address - Fax:
Practice Address - Street 1:515 E DIVISION ST STE 125
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-1378
Practice Address - Country:US
Practice Address - Phone:616-863-1020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008541111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4410455Medicaid
MIU89962Medicare UPIN
MIE96305003Medicare ID - Type Unspecified