Provider Demographics
NPI:1174719272
Name:DIANA CHIROPRACTIC CENTER, PC
Entity type:Organization
Organization Name:DIANA CHIROPRACTIC CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:DIANA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:570-455-8141
Mailing Address - Street 1:1056 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18202-1707
Mailing Address - Country:US
Mailing Address - Phone:570-455-8141
Mailing Address - Fax:570-455-8153
Practice Address - Street 1:1056 GRANT ST
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18202-1707
Practice Address - Country:US
Practice Address - Phone:570-455-8141
Practice Address - Fax:570-455-8153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA130905OtherBLUE SHIELD
PA0017511560001Medicaid
PA130905Medicare PIN