Provider Demographics
NPI:1033290473
Name:RESNICK, DIANE NATALIE (DC)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:NATALIE
Last Name:RESNICK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 BAY AREA BLVD APT 1327
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-1121
Mailing Address - Country:US
Mailing Address - Phone:818-524-0369
Mailing Address - Fax:
Practice Address - Street 1:4300 BAY AREA BLVD APT 1327
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-1121
Practice Address - Country:US
Practice Address - Phone:818-524-0369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2011-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25494111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0254940OtherB SHIELD
CAWDC25494AMedicare ID - Type Unspecified
CADC0254940OtherB SHIELD