Provider Demographics
NPI:1033281456
Name:DIAMOND, ELISSA (DC)
Entity Type:Individual
Prefix:DR
First Name:ELISSA
Middle Name:
Last Name:DIAMOND
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:ELISSA
Other - Middle Name:
Other - Last Name:DIAMOND-FIELDS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:1250 SUMMER ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-5358
Mailing Address - Country:US
Mailing Address - Phone:203-327-3222
Mailing Address - Fax:203-978-9079
Practice Address - Street 1:1250 SUMMER ST
Practice Address - Street 2:SUITE 202
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5358
Practice Address - Country:US
Practice Address - Phone:203-327-3222
Practice Address - Fax:203-978-9079
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1322111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTU83998Medicare UPIN