Provider Demographics
NPI:1700870706
Name:WARDENBURG, MARK (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:WARDENBURG
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 1:18124 CULVER DR
Mailing Address - Street 2:SUITE F
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-2729
Mailing Address - Country:US
Mailing Address - Phone:949-552-9393
Mailing Address - Fax:949-552-5872
Practice Address - Street 1:18124 CULVER DR
Practice Address - Street 2:SUITE F
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-2729
Practice Address - Country:US
Practice Address - Phone:949-552-9393
Practice Address - Fax:949-552-5872
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24241111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV60238Medicare UPIN