Healthcare Provider Details

I. General information

NPI: 1154156495
Provider Name (Legal Business Name): BURT RODRIQUEZ HUFF JR. DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2024
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2765 S MARKET ST STE 105
GILBERT AZ
85295-1305
US

IV. Provider business mailing address

2765 S MARKET ST STE 105
GILBERT AZ
85295-1305
US

V. Phone/Fax

Practice location:
  • Phone: 480-963-1363
  • Fax:
Mailing address:
  • Phone: 480-963-1363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number9338
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: