1114127032 NPI number — DIAMOND CHIROPRACTIC PS

Table of content: (NPI 1114127032)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114127032 NPI number — DIAMOND CHIROPRACTIC PS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIAMOND CHIROPRACTIC PS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DIAMOND CHIROPRACTIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114127032
Entity Type Code:
Organization
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:
294 TORBETT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHLAND
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99354
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-943-5533
Provider Business Mailing Address Fax Number:
509-943-3155

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
294 TORBETT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHLAND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99354-2664
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-943-5533
Provider Business Practice Location Address Fax Number:
509-943-3155
Provider Enumeration Date:
07/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BETZLER
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
JOHN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
509-943-5533

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CH0002853 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: CH000034239 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: AB35423 . This is a "MEDICARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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