Provider Demographics
NPI:1144529025
Name:BURKENSTOCK, CHRISTOPHER ROSS
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:ROSS
Last Name:BURKENSTOCK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 MELODY DR
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-6306
Mailing Address - Country:US
Mailing Address - Phone:985-705-4168
Mailing Address - Fax:
Practice Address - Street 1:612 MELODY DR
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-6306
Practice Address - Country:US
Practice Address - Phone:985-705-4168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-18
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program