Provider Demographics
NPI:1043332679
Name:NEUBAUER, DIANA LIND (DOCTOR OF CHIROPRACT)
Entity Type:Individual
Prefix:MISS
First Name:DIANA
Middle Name:LIND
Last Name:NEUBAUER
Suffix:
Gender:F
Credentials:DOCTOR OF CHIROPRACT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1813 B PROFESSIONAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-2106
Mailing Address - Country:US
Mailing Address - Phone:916-483-9080
Mailing Address - Fax:916-483-9078
Practice Address - Street 1:1813 B PROFESSIONAL DRIVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-2106
Practice Address - Country:US
Practice Address - Phone:916-483-9080
Practice Address - Fax:916-483-9078
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC158420111N00000X
KYDC3391111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5790812Medicaid
CA5790812Medicaid