Provider Demographics
NPI:1114035904
Name:WELTY, DIANNA (DC)
Entity Type:Individual
Prefix:
First Name:DIANNA
Middle Name:
Last Name:WELTY
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:P.O. BOX 270345
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-0345
Mailing Address - Country:US
Mailing Address - Phone:414-529-4180
Mailing Address - Fax:414-858-9082
Practice Address - Street 1:125 E. ADAMS ST.
Practice Address - Street 2:
Practice Address - City:CLAY CITY
Practice Address - State:IL
Practice Address - Zip Code:62824
Practice Address - Country:US
Practice Address - Phone:618-676-1532
Practice Address - Fax:618-676-1404
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1-332004OtherBCBS
ILP00267817OtherRAILROAD MEDICARE
ILV02372Medicare UPIN
ILP00267817OtherRAILROAD MEDICARE
IL1-332004OtherBCBS