Provider Demographics
NPI:1861663320
Name:BURDI CHIROPRACTIC
Entity type:Organization
Organization Name:BURDI CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:F
Authorized Official - Last Name:BURDI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:949-770-6922
Mailing Address - Street 1:22762 ASPAN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-1604
Mailing Address - Country:US
Mailing Address - Phone:949-770-6922
Mailing Address - Fax:949-770-6923
Practice Address - Street 1:22762 ASPAN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-1604
Practice Address - Country:US
Practice Address - Phone:949-770-6922
Practice Address - Fax:949-770-6923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12621111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0126210OtherBLUE SHIELD
CADC12621Medicare PIN
CADC0126210OtherBLUE SHIELD