Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 27 1595 | OR |
NPI | 1578501755 |
---|---|
Provider Name | Dr. Michael J. Burke |
First Address | Bandon, OR 97411 |
Second Address | Coos Bay, OR 97420-1555 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2006 |
Last Update Date | 30/12/2021 |