Provider Demographics
NPI:1265581292
Name:MIGIRDICHIAN, KAMER (DC)
Entity type:Individual
Prefix:DR
First Name:KAMER
Middle Name:
Last Name:MIGIRDICHIAN
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 1:4100 BIRCH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2275
Mailing Address - Country:US
Mailing Address - Phone:949-417-0420
Mailing Address - Fax:877-631-2676
Practice Address - Street 1:4100 BIRCH ST STE 200
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2275
Practice Address - Country:US
Practice Address - Phone:949-417-0420
Practice Address - Fax:877-631-2676
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24509111N00000X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU63154Medicare UPIN