Provider Demographics
NPI:1083998207
Name:DIEHL CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:DIEHL CHIROPRACTIC, INC.
Other - Org Name:MAXIMIZED LIFE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:DIEHL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:805-496-1000
Mailing Address - Street 1:2900 TOWNSGATE RD
Mailing Address - Street 2:SUITE 212
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-3001
Mailing Address - Country:US
Mailing Address - Phone:805-496-1000
Mailing Address - Fax:805-496-1011
Practice Address - Street 1:2900 TOWNSGATE RD
Practice Address - Street 2:SUITE 212
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-3001
Practice Address - Country:US
Practice Address - Phone:805-496-1000
Practice Address - Fax:805-496-1011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25686111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty