Provider Demographics
NPI:1922163625
Name:BURDI, GEORGE F (DC)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:F
Last Name:BURDI
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 1:21826 NORTHWOOD LN
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-2441
Mailing Address - Country:US
Mailing Address - Phone:714-330-6923
Mailing Address - Fax:949-770-6923
Practice Address - Street 1:23028 LAKE FOREST DR STE D
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1323
Practice Address - Country:US
Practice Address - Phone:714-330-6923
Practice Address - Fax:714-330-6923
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-25
Last Update Date:2024-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12621111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0126210OtherBLUE SHIELD
CADC12621Medicare ID - Type UnspecifiedMEDICARE
CAT04828Medicare UPIN