Provider Demographics
NPI:1679729552
Name:DIGRADO, MIKE JAMES (DC)
Entity type:Individual
Prefix:
First Name:MIKE
Middle Name:JAMES
Last Name:DIGRADO
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 1:363 SAN MIGUEL DR STE 191
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7898
Mailing Address - Country:US
Mailing Address - Phone:949-640-1470
Mailing Address - Fax:
Practice Address - Street 1:363 SAN MIGUEL DR STE 191
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7898
Practice Address - Country:US
Practice Address - Phone:949-640-1470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28885111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor