Provider Demographics
NPI:1366434714
Name:NAVARRO, DIANE J (DC)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:J
Last Name:NAVARRO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:J
Other - Last Name:RUSNAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:201 SCOTCH RD
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08628-2511
Mailing Address - Country:US
Mailing Address - Phone:609-530-1400
Mailing Address - Fax:609-530-1400
Practice Address - Street 1:201 SCOTCH RD
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08628-2511
Practice Address - Country:US
Practice Address - Phone:609-530-1400
Practice Address - Fax:609-530-1400
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00318000111N00000X
PADC002954L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NA539853Medicare PIN
U24657Medicare UPIN