Provider Demographics
NPI:1902950926
Name:BURNS, RONDALL SCOTT (DC)
Entity Type:Individual
Prefix:DR
First Name:RONDALL
Middle Name:SCOTT
Last Name:BURNS
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 1:580D E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:TN
Mailing Address - Zip Code:38340-2418
Mailing Address - Country:US
Mailing Address - Phone:731-989-5897
Mailing Address - Fax:731-989-5897
Practice Address - Street 1:580D E MAIN ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:TN
Practice Address - Zip Code:38340-2418
Practice Address - Country:US
Practice Address - Phone:731-989-5897
Practice Address - Fax:731-989-5897
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC809111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3676291Medicare ID - Type Unspecified