1104807494 NPI number — DR. DIANE LEE MICHAELS D.C.

Table of content: DR. DIANE LEE MICHAELS D.C. (NPI 1104807494)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104807494 NPI number — DR. DIANE LEE MICHAELS D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MICHAELS
Provider First Name:
DIANE
Provider Middle Name:
LEE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HOROWITZ
Provider Other First Name:
DIANE
Provider Other Middle Name:
LEE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.C.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1104807494
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 VILLAGE GREEN PKWY
Provider Second Line Business Mailing Address:
SUITE 15
Provider Business Mailing Address City Name:
BRADENTON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34209-3404
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-761-0210
Provider Business Mailing Address Fax Number:
941-795-0708

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 VILLAGE GREEN PKWY
Provider Second Line Business Practice Location Address:
SUITE 15
Provider Business Practice Location Address City Name:
BRADENTON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34209-3404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-761-0210
Provider Business Practice Location Address Fax Number:
941-795-0708
Provider Enumeration Date:
11/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CH0006891 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 10715738 . This is a "CAQH" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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