Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | C792 | ID |
NPI | 1386709806 |
---|---|
Provider Name | Dr. Terry Lynn Burke |
First Address | Idaho Falls, ID 83404-6270 |
Second Address | Idaho Falls, ID 83404-6270 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1740281435 | INC NPI (01) | ID |
T04527 | (02) | ID |