Provider Demographics
NPI:1679799951
Name:BURATOVICH, NICK DENISS (ND)
Entity Type:Individual
Prefix:DR
First Name:NICK
Middle Name:DENISS
Last Name:BURATOVICH
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:742 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-6409
Mailing Address - Country:US
Mailing Address - Phone:480-649-5008
Mailing Address - Fax:
Practice Address - Street 1:2435 EAST SOUTHERN AVE
Practice Address - Street 2:SUITE 9
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7628
Practice Address - Country:US
Practice Address - Phone:480-831-0717
Practice Address - Fax:480-345-9336
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ84-361175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath