Provider Demographics
NPI:1912072182
Name:DR MARK B BURDORF PC
Entity Type:Organization
Organization Name:DR MARK B BURDORF PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:B
Authorized Official - Last Name:BURDORF
Authorized Official - Suffix:
Authorized Official - Credentials:DC DACNB
Authorized Official - Phone:480-951-5006
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
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
Practice Address - Country:US
Practice Address - Phone:480-951-5006
Practice Address - Fax:480-951-1588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4423111N00000X
DIPLOMATE #328111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AW2655OtherHEALTH NET
AZAZ0930740OtherBCBS
Z63117Medicare PIN