Provider Demographics
NPI:1104883446
Name:KERRI L BURGESS DC PC
Entity type:Organization
Organization Name:KERRI L BURGESS DC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KERRI
Authorized Official - Middle Name:L
Authorized Official - Last Name:BURGESS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-987-6372
Mailing Address - Street 1:5745 N SCOTTSDALE RD
Mailing Address - Street 2:#B100
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85250-5902
Mailing Address - Country:US
Mailing Address - Phone:480-990-0004
Mailing Address - Fax:480-990-3334
Practice Address - Street 1:5745 N SCOTTSDALE RD
Practice Address - Street 2:#B100
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85250-5902
Practice Address - Country:US
Practice Address - Phone:480-990-0004
Practice Address - Fax:480-990-3334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7547111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZU95589Medicare UPIN
AZZ102031Medicare PIN