Kevin Burroughs, DC
Individual provider Active NPI Chiropractor · Lakewood, OH
NPI 1578070280 · NPPES record last updated Dec 5, 2019
Key facts
- NPI
- 1578070280
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- DC-04788 (OH)
- Practice address
- 15713 Detroit Ave
Lakewood, OH 44107-3709 - Phone
- (330) 554-4232
- NPI assigned
- Jan 3, 2018
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231016002058 | OH | Practitioner - Chiropractic | 4789019100 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ohio Sports Chiropractic | Chiropractor | Past |
Accepting new patients |
| Infupoint Care Consultants, LLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | DC-04788 | OH | Yes |
Addresses
Primary practice location
15713 Detroit Ave
Lakewood, OH 44107-3709
Mailing address
6018 Madison Ave
Cleveland, OH 44102-4356
Phone (330) 554-4232
Other providers in Lakewood, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 5, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.