Provider Demographics
NPI:1730276684
Name:BURTON, TRISTAN SIDNEY (DC)
Entity type:Individual
Prefix:DR
First Name:TRISTAN
Middle Name:SIDNEY
Last Name:BURTON
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 1:2349 MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-3025
Mailing Address - Country:US
Mailing Address - Phone:585-442-6030
Mailing Address - Fax:585-442-2977
Practice Address - Street 1:2349 MONROE AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-3025
Practice Address - Country:US
Practice Address - Phone:585-442-6030
Practice Address - Fax:585-442-2977
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010672111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDD5578Medicare ID - Type Unspecified
NYU95225Medicare UPIN