Provider Demographics
NPI:1699040865
Name:SEMERDJIEV, IVAN GEORGE (DC)
Entity Type:Individual
Prefix:
First Name:IVAN
Middle Name:GEORGE
Last Name:SEMERDJIEV
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 1:6244 EL CAJON BLVD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-3918
Mailing Address - Country:US
Mailing Address - Phone:619-326-0606
Mailing Address - Fax:619-326-0626
Practice Address - Street 1:6244 EL CAJON BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-3918
Practice Address - Country:US
Practice Address - Phone:619-326-0606
Practice Address - Fax:619-326-0626
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-20
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32247111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor