Provider Demographics
NPI:1447510193
Name:BURNETT, BRIAN CRAIG (DC)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:CRAIG
Last Name:BURNETT
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 1:320 1ST ST N
Mailing Address - Street 2:SUITE 602
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-6944
Mailing Address - Country:US
Mailing Address - Phone:904-270-2673
Mailing Address - Fax:904-212-0024
Practice Address - Street 1:320 1ST ST N
Practice Address - Street 2:SUITE 602
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-6944
Practice Address - Country:US
Practice Address - Phone:904-270-2673
Practice Address - Fax:904-212-0024
Is Sole Proprietor?:No
Enumeration Date:2012-05-29
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10679111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor