Provider Demographics
NPI:1235415670
Name:LAM, DIANA (DC)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:
Last Name:LAM
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 1:11633 SW 59TH CT
Mailing Address - Street 2:
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33330-4157
Mailing Address - Country:US
Mailing Address - Phone:954-931-0472
Mailing Address - Fax:
Practice Address - Street 1:18501 PINES BLVD STE 104
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-1414
Practice Address - Country:US
Practice Address - Phone:954-432-3343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-31
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008845111N00000X
GACHIR008846111N00000X
WACH60742209111N00000X
FLCH 10709111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor