Shannon Doak Burke, D.C.
Individual provider Active NPI Chiropractor · Vidor, TX
NPI 1528077823 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1528077823
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 5849 (TX)
- Practice address
- 360 S Main St
Vidor, TX 77662-5752 - Phone
- (409) 769-5115
- Fax
- (409) 769-5215
- NPI assigned
- Aug 5, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5849 | TX | MD | Chiropractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 5849 | TX | Yes |
Addresses
Primary practice location
360 S Main St
Vidor, TX 77662-5752
Mailing address
PO Box 277
Vidor, TX 77670-0277
Phone (409) 769-5115
Other providers in Vidor, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.