Basic Information
Provider Information | |||||||||
NPI: | 1033164520 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BURNETT | ||||||||
FirstName: | JAMES | ||||||||
MiddleName: | MATTHEW | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | D.C. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 3540 WASHINGTON RD | ||||||||
Address2: |   | ||||||||
City: | MC MURRAY | ||||||||
State: | PA | ||||||||
PostalCode: | 153172957 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7249410707 | ||||||||
FaxNumber: | 7249417772 | ||||||||
Practice Location | |||||||||
Address1: | 3540 WASHINGTON RD | ||||||||
Address2: |   | ||||||||
City: | MC MURRAY | ||||||||
State: | PA | ||||||||
PostalCode: | 153172957 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7249410707 | ||||||||
FaxNumber: | 7249417772 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/23/2006 | ||||||||
LastUpdateDate: | 03/19/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | DC009236 | PA | Y |   | Chiropractic Providers | Chiropractor |   |
ID Information
ID | Type | State | Issuer | Description | 11268054 | 01 | PA | AETNA ID NUMBER | OTHER | 410191 | 01 | PA | UPMC PROVIDER NUMBER | OTHER | 667116 | 01 | PA | UNITED HEALTH CARE ID | OTHER | 5447095 | 01 | PA | CIGNA ID NUMBER | OTHER | 615305 | 01 | PA | HIGHMARK BC/BS ID NUMBER | OTHER |