Provider Demographics
NPI:1073791885
Name:BURDORF, MARK B (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:B
Last Name:BURDORF
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8140 E CACTUS RD
Mailing Address - Street 2:SUITE 730
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-5268
Mailing Address - Country:US
Mailing Address - Phone:480-951-5006
Mailing Address - Fax:480-951-1588
Practice Address - Street 1:8140 E CACTUS RD
Practice Address - Street 2:SUITE 730
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-5268
Practice Address - Country:US
Practice Address - Phone:480-951-5006
Practice Address - Fax:480-951-1588
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-04
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4423111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0930740OtherBCBS
AZAW2655OtherHEALTH NET
AZAZ0930740OtherBCBS