Individual
JACK BULLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3100 W RAY RD STE 201, CHANDLER, AZ 85226-2472
(602) 892-8680
(480) 936-7565
Mailing address
18001 N 79TH AVE STE A12, GLENDALE, AZ 85308-8398
(623) 399-6825
(623) 505-3474
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86375126
AZ
Other
Enumeration date
10/27/2025
Last updated
10/27/2025
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