Provider Demographics
NPI:1073580882
Name:DIETER, CARL F (DC)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:F
Last Name:DIETER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5570 SANCHEZ DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-1119
Mailing Address - Country:US
Mailing Address - Phone:408-262-7111
Mailing Address - Fax:408-266-4872
Practice Address - Street 1:5570 SANCHEZ DR STE 100
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-1119
Practice Address - Country:US
Practice Address - Phone:408-262-7111
Practice Address - Fax:408-266-4872
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0111260111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT04205Medicare UPIN
CADC0111260Medicare ID - Type Unspecified