Provider Demographics
NPI:1043917008
Name:BURRIS, LANDON DANIEL (DC)
Entity type:Individual
Prefix:DR
First Name:LANDON
Middle Name:DANIEL
Last Name:BURRIS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 KENMOOR AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-2390
Mailing Address - Country:US
Mailing Address - Phone:616-333-2322
Mailing Address - Fax:
Practice Address - Street 1:833 KENMOOR AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-2390
Practice Address - Country:US
Practice Address - Phone:616-333-2322
Practice Address - Fax:616-772-9258
Is Sole Proprietor?:No
Enumeration Date:2023-02-10
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3676111N00000X
MI2301010726111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor