Provider Demographics
NPI:1144735242
Name:BURCHETT, BRENTON (DC)
Entity type:Individual
Prefix:DR
First Name:BRENTON
Middle Name:
Last Name:BURCHETT
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 1:2645 GREEN FARM RD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24540-0211
Mailing Address - Country:US
Mailing Address - Phone:434-607-2406
Mailing Address - Fax:
Practice Address - Street 1:5701 GEORGE WASHINGTON MEM HWY
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23692-2773
Practice Address - Country:US
Practice Address - Phone:757-874-5666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-11
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557454111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor