Provider Demographics
NPI:1497866768
Name:SARDONE, MICHAEL R (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:R
Last Name:SARDONE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4653 CARMEL MOUNTAIN RD
Mailing Address - Street 2:STE 308-417
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-6650
Mailing Address - Country:US
Mailing Address - Phone:866-355-8288
Mailing Address - Fax:866-355-8288
Practice Address - Street 1:12865 POINTE DEL MAR WAY
Practice Address - Street 2:STE 120
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-3860
Practice Address - Country:US
Practice Address - Phone:866-355-8288
Practice Address - Fax:866-355-8288
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13667111NN1001X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
No111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT17569Medicare UPIN