Provider Demographics
NPI:1083477855
Name:DIEKEN, IZABELLA RAEH (DC)
Entity Type:Individual
Prefix:
First Name:IZABELLA
Middle Name:RAEH
Last Name:DIEKEN
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 1:3513 WELCOME AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55422-2635
Mailing Address - Country:US
Mailing Address - Phone:507-828-6434
Mailing Address - Fax:
Practice Address - Street 1:2822 W 43RD ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55410-1696
Practice Address - Country:US
Practice Address - Phone:612-767-4680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7208111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor