Healthcare Provider Details

I. General information

NPI: 1912102062
Provider Name (Legal Business Name): NEWPORT CHIROPRACTIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 02/19/2024
Certification Date: 02/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 BIRCH ST STE 200
NEWPORT BEACH CA
92660-2275
US

IV. Provider business mailing address

4100 BIRCH ST STE 200
NEWPORT BEACH CA
92660-2275
US

V. Phone/Fax

Practice location:
  • Phone: 949-417-0420
  • Fax: 877-631-2676
Mailing address:
  • Phone: 949-417-0420
  • Fax: 877-631-2676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC24509
License Number StateCA

VIII. Authorized Official

Name: KAMER MIGIRDICHIAN
Title or Position: OWNER
Credential:
Phone: 949-417-0420