Provider Demographics
NPI:1568657351
Name:POLADIAN & MAMIGONIAN
Entity Type:Organization
Organization Name:POLADIAN & MAMIGONIAN
Other - Org Name:WESTSIDE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MAMIGONIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:559-930-9351
Mailing Address - Street 1:1107 O ST
Mailing Address - Street 2:
Mailing Address - City:FIREBAUGH
Mailing Address - State:CA
Mailing Address - Zip Code:93622-2224
Mailing Address - Country:US
Mailing Address - Phone:559-659-9000
Mailing Address - Fax:559-659-9017
Practice Address - Street 1:1107 O ST
Practice Address - Street 2:
Practice Address - City:FIREBAUGH
Practice Address - State:CA
Practice Address - Zip Code:93622-2224
Practice Address - Country:US
Practice Address - Phone:559-659-9000
Practice Address - Fax:559-659-9017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21046111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ269732OtherMCARE
CAZZZ269732OtherMCARE
CAU40214Medicare UPIN