Provider Demographics
NPI:1356822878
Name:DIGRADO NEWPORT CENTER FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:DIGRADO NEWPORT CENTER FAMILY CHIROPRACTIC
Other - Org Name:NEWPORT CENTER FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:DIGRADO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:949-640-1470
Mailing Address - Street 1:359 SAN MIGUEL DR STE 203
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7808
Mailing Address - Country:US
Mailing Address - Phone:949-640-1470
Mailing Address - Fax:
Practice Address - Street 1:359 SAN MIGUEL DR STE 203
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7808
Practice Address - Country:US
Practice Address - Phone:949-640-1470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28885111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1679729552OtherPERSONAL