Provider Demographics
NPI:1225277940
Name:MLADENOFF, DIANA VASSELLE (DC)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:VASSELLE
Last Name:MLADENOFF
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 1:11021 METCALF AVE
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-1815
Mailing Address - Country:US
Mailing Address - Phone:913-491-1071
Mailing Address - Fax:913-451-8566
Practice Address - Street 1:11021 METCALF AVE
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-1815
Practice Address - Country:US
Practice Address - Phone:913-491-1071
Practice Address - Fax:913-451-8566
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-19
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05214111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor