Provider Demographics
NPI:1699711077
Name:BUDINCICH, MICHAEL NICHOLAS (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:NICHOLAS
Last Name:BUDINCICH
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 1:140 N HILL AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-1907
Mailing Address - Country:US
Mailing Address - Phone:818-792-3390
Mailing Address - Fax:626-792-8302
Practice Address - Street 1:140 N HILL AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-1907
Practice Address - Country:US
Practice Address - Phone:818-792-3390
Practice Address - Fax:626-792-8302
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAQME 006232111NX0100X
CADC-13956111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NX0100XChiropractic ProvidersChiropractorOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1770764474OtherNPI
CAT17657Medicare UPIN