Provider Demographics
NPI:1235139015
Name:DIEHL, THAD NATHAN (DC)
Entity Type:Individual
Prefix:
First Name:THAD
Middle Name:NATHAN
Last Name:DIEHL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 E MILL ST
Mailing Address - Street 2:
Mailing Address - City:PORT ALLEGANY
Mailing Address - State:PA
Mailing Address - Zip Code:16743-9743
Mailing Address - Country:US
Mailing Address - Phone:814-642-7236
Mailing Address - Fax:814-313-7535
Practice Address - Street 1:717 E MILL ST
Practice Address - Street 2:
Practice Address - City:PORT ALLEGANY
Practice Address - State:PA
Practice Address - Zip Code:16743-9743
Practice Address - Country:US
Practice Address - Phone:814-642-7236
Practice Address - Fax:814-313-7535
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-22
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009168111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1010002500001Medicaid
PADI1608783OtherBLUE CROSS BLUE SHIELD
PA1010002500001Medicaid
PADI1608783OtherBLUE CROSS BLUE SHIELD