MEDICARE: DR. MARK WARDENBURG D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NX0800X	Orthopedic Chiropractor	DC24241	CA

General Provider Information

NPI Number	:	1700870706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK WARDENBURG D.C.

Provider Business Mailing Address
First Line	:	18124 CULVER DR
Second Line	:	SUITE F
City	:	IRVINE
State	:	CA
Zip	:	92612-2729
Country	:	US
Telephone Number	:	949-552-9393
Fax Number	:	949-552-5872

Provider Business Practice Location Address
First Line	:	18124 CULVER DR
Second Line	:	SUITE F
City	:	IRVINE
State	:	CA
Zip	:	92612-2729
Country	:	US
Telephone Number	:	949-552-9393
Fax Number	:	949-552-5872

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2005
Last Update Date	:	07/08/2007

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