Provider Demographics
NPI:1013193812
Name:DIAZ CHIROPRACTIC
Entity Type:Organization
Organization Name:DIAZ CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:619-216-7628
Mailing Address - Street 1:680 OLD TELEGRAPH CANYON RD
Mailing Address - Street 2:STE. 104
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-6552
Mailing Address - Country:US
Mailing Address - Phone:619-216-7628
Mailing Address - Fax:619-216-7820
Practice Address - Street 1:680 OLD TELEGRAPH CANYON RD
Practice Address - Street 2:STE. 104
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-6552
Practice Address - Country:US
Practice Address - Phone:619-216-7628
Practice Address - Fax:619-216-7820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty