Provider Demographics
NPI:1174588719
Name:PELRINE-BURBANK, SUSAN (DC)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:PELRINE-BURBANK
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 44
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02334-0044
Mailing Address - Country:US
Mailing Address - Phone:508-230-0020
Mailing Address - Fax:508-230-0021
Practice Address - Street 1:45 EASTMAN ST
Practice Address - Street 2:
Practice Address - City:SOUTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02375-1279
Practice Address - Country:US
Practice Address - Phone:508-230-0020
Practice Address - Fax:508-230-0021
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1934111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY39243OtherBCBS OF MA
MA2148179OtherAETNA
MA351262OtherHARVARD
MAY45165Medicare ID - Type UnspecifiedMEDICARE NUMBER
MA351262OtherHARVARD