Provider Demographics
NPI:1114127032
Name:DIAMOND CHIROPRACTIC PS
Entity Type:Organization
Organization Name:DIAMOND CHIROPRACTIC PS
Other - Org Name:DIAMOND CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:BETZLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:509-943-5533
Mailing Address - Street 1:294 TORBETT ST
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99354
Mailing Address - Country:US
Mailing Address - Phone:509-943-5533
Mailing Address - Fax:509-943-3155
Practice Address - Street 1:294 TORBETT ST
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99354-2664
Practice Address - Country:US
Practice Address - Phone:509-943-5533
Practice Address - Fax:509-943-3155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH0002853111N00000X
WACH000034239111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB35423OtherMEDICARE
WAAB35423OtherMEDICARE