Healthcare Provider Details

I. General information

NPI: 1912072182
Provider Name (Legal Business Name): DR MARK B BURDORF PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 02/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8140 E CACTUS RD SUITE 730
SCOTTSDALE AZ
85260
US

IV. Provider business mailing address

8140 E CACTUS RD SUITE 730
SCOTTSDALE AZ
85260
US

V. Phone/Fax

Practice location:
  • Phone: 480-951-5006
  • Fax: 480-951-1588
Mailing address:
  • Phone: 480-951-5006
  • Fax: 480-951-1588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4423
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License NumberDIPLOMATE #328
License Number State

VIII. Authorized Official

Name: DR. MARK B BURDORF
Title or Position: DOCTOR OWNER
Credential: DC DACNB
Phone: 480-951-5006