1205933306 NPI number — DIANNE L. COMO, DC, PA

Table of content: (NPI 1205933306)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205933306 NPI number — DIANNE L. COMO, DC, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIANNE L. COMO, DC, PA
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:
Provider Other Organization Name Type Code:
6
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:
1205933306
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
669 WINNETKA AVE N
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
GOLDEN VALLEY
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55427-4574
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-595-9096
Provider Business Mailing Address Fax Number:
763-595-0291

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
669 WINNETKA AVE N
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
GOLDEN VALLEY
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55427-4574
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-595-9096
Provider Business Practice Location Address Fax Number:
763-595-0291
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COMO
Authorized Official First Name:
DIANNE
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
OWNER/PRESIDENT/CHIROPRACTOR
Authorized Official Telephone Number:
763-595-9096

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  3191 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 55F12CO . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 889027700 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com