Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jack Bullard

Individual provider Registered Dietitian · NPI 1568330983

Jack Bullard is a Registered Dietitian OR Nutrition Professional in Chandler, Arizona. Qualified in 2025, 1 year ago. Licensed in Arizona.

Years since qualifying
1
Licensed in
AZ
In the registry since
2025
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Practice location Address checks out

3100 W Ray Rd Ste 201
Chandler, AZ 85226-2472
Phone: (602) 892-8680
Fax: (480) 936-7565
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Registered Dietitian (primary) Taxonomy 133V00000X · Licence 86375126 (AZ)

Record details

NPI number1568330983
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedOctober 27, 2025
Last updated in NPPESOctober 27, 2025
Certification dateOctober 27, 2025
Mailing address18001 N 79th Ave Ste A12, Glendale, AZ 85308-8398

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyREGISTERED DIETITIAN OR NUTRITION PROFESSIONAL
Medical schoolOTHER
Graduated 2025 (1 years in practice)
Accepts Medicare assignment Not indicated

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