Healthcare Provider Details

I. General information

NPI: 1699711077
Provider Name (Legal Business Name): MICHAEL NICHOLAS BUDINCICH D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 02/15/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 N HILL AVE
PASADENA CA
91106-1907
US

IV. Provider business mailing address

140 N HILL AVE
PASADENA CA
91106-1907
US

V. Phone/Fax

Practice location:
  • Phone: 818-792-3390
  • Fax: 626-792-8302
Mailing address:
  • Phone: 818-792-3390
  • Fax: 626-792-8302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NX0100X
TaxonomyOccupational Health Chiropractor
License NumberQME 006232
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC-13956
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: