Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | CHIRO07709 | GA |
N | 111NN0400X | Neurology | CHIRO07709 | GA |
N | 111NR0200X | Radiology | CHIRO07709 | GA |
N | 213ER0200X | Radiology | CHIRO07709 | GA |
N | 111NR0400X | Rehabilitation Chiropractor | CHIRO07709 | GA |
N | 111NS0005X | Chiropractic Sports Physician | CHIRO07709 | GA |
N | 111NT0100X | Thermography | CHIRO07709 | GA |
N | 111NX0800X | Chiropractor Orthopedic Specialist | CHIRO07709 | GA |
NPI | 1578787651 |
---|---|
Provider Name | Stephanie Michelle Burry |
First Address | Lawrenceville, GA 30043-3039 |
Second Address | Duluth, GA 30096-1623 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2007 |
Last Update Date | 08/07/2007 |