Provider Demographics
NPI:1174692982
Name:BURLE, KENNETH GERARD JR (DC)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:GERARD
Last Name:BURLE
Suffix:JR
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 1:422 W LOVE ST
Mailing Address - Street 2:
Mailing Address - City:MEXICO
Mailing Address - State:MO
Mailing Address - Zip Code:65265-2704
Mailing Address - Country:US
Mailing Address - Phone:573-581-0381
Mailing Address - Fax:573-581-0381
Practice Address - Street 1:422 W LOVE ST
Practice Address - Street 2:
Practice Address - City:MEXICO
Practice Address - State:MO
Practice Address - Zip Code:65265-2704
Practice Address - Country:US
Practice Address - Phone:573-581-0381
Practice Address - Fax:573-581-0381
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007021191111N00000X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation