Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | CHI-CHI-LIC-2372 | MT |
N | 111NR0400X | Rehabilitation Chiropractor | CHIR008124 | GA |
NPI | 1043363112 |
---|---|
Provider Name | Dr. Mary Ellen Burton |
First Address | Anaconda, MT 59711-2351 |
Second Address | Anaconda, MT 59711-2351 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2007 |
Last Update Date | 07/03/2019 |