Provider Demographics
NPI:1043361769
Name:DIANA, JAMES MICHAEL JR (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MICHAEL
Last Name:DIANA
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:6990 E SHEA BLVD
Mailing Address - Street 2:#114
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-5208
Mailing Address - Country:US
Mailing Address - Phone:480-348-9600
Mailing Address - Fax:480-348-5635
Practice Address - Street 1:6990 E SHEA BLVD
Practice Address - Street 2:#114
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-5208
Practice Address - Country:US
Practice Address - Phone:480-348-9600
Practice Address - Fax:480-348-5635
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7339111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAW7090OtherHEALTH NET
AZAZ0945500OtherBCBS
AZAW7090OtherHEALTH NET