Provider Demographics
NPI:1871585844
Name:BURMEISTER, KATIE JEANNINE (DC)
Entity type:Individual
Prefix:DR
First Name:KATIE
Middle Name:JEANNINE
Last Name:BURMEISTER
Suffix:
Gender:F
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:PO BOX 86
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:IL
Mailing Address - Zip Code:62881-0086
Mailing Address - Country:US
Mailing Address - Phone:618-740-1711
Mailing Address - Fax:618-662-4830
Practice Address - Street 1:120 S DELMAR AVE STE B
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:IL
Practice Address - Zip Code:62881-2000
Practice Address - Country:US
Practice Address - Phone:618-401-7117
Practice Address - Fax:618-662-4830
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009763111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038009763Medicaid
IL203843Medicare ID - Type Unspecified
ILU84913Medicare UPIN