Provider Demographics
NPI:1134266489
Name:BURCH, DWAYNE LEE (DC)
Entity type:Individual
Prefix:DR
First Name:DWAYNE
Middle Name:LEE
Last Name:BURCH
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 1:1108 W AIRLINE HWY
Mailing Address - Street 2:
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-3717
Mailing Address - Country:US
Mailing Address - Phone:985-652-7904
Mailing Address - Fax:985-651-2981
Practice Address - Street 1:1959 HIGHWAY 3125
Practice Address - Street 2:SUITE 3
Practice Address - City:LUTCHER
Practice Address - State:LA
Practice Address - Zip Code:70071-5640
Practice Address - Country:US
Practice Address - Phone:225-869-7904
Practice Address - Fax:225-869-8600
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA407111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor