Provider Demographics
NPI:1386717981
Name:BURDETTE, MARK W (DC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:W
Last Name:BURDETTE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13029 POMERADO RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-4246
Mailing Address - Country:US
Mailing Address - Phone:858-486-1222
Mailing Address - Fax:858-513-2088
Practice Address - Street 1:13029 POMERADO RD
Practice Address - Street 2:SUITE A
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-4246
Practice Address - Country:US
Practice Address - Phone:858-486-1222
Practice Address - Fax:858-513-2088
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CADC27393111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor