Provider Demographics
NPI:1548730575
Name:BURKE, DANIELLE CHRISTINE (MTOM, LAC)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:CHRISTINE
Last Name:BURKE
Suffix:
Gender:F
Credentials:MTOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1827 12TH ST APT 4
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-4621
Mailing Address - Country:US
Mailing Address - Phone:310-699-6683
Mailing Address - Fax:
Practice Address - Street 1:1827 12TH ST APT 4
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-4621
Practice Address - Country:US
Practice Address - Phone:310-699-6683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18151171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist