Provider Demographics
NPI:1760501670
Name:BURLESON CHIROPRACTIC CENTER INC
Entity type:Organization
Organization Name:BURLESON CHIROPRACTIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARKUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-447-6400
Mailing Address - Street 1:1161 SW WILSHIRE BLVD STE 132
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-5797
Mailing Address - Country:US
Mailing Address - Phone:817-447-6400
Mailing Address - Fax:603-658-2871
Practice Address - Street 1:1161 SW WILSHIRE BLVD STE 132
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-5797
Practice Address - Country:US
Practice Address - Phone:817-447-6400
Practice Address - Fax:603-658-2871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC4098111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0027JHOtherBCBS