Provider Demographics
NPI:1275631079
Name:DIANA, JAMES MICHAEL
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:MICHAEL
Last Name:DIANA
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:JAMES
Other - Middle Name:M
Other - Last Name:DIANA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:3650 WEST BETHANY HOME ROAD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85019-1967
Mailing Address - Country:US
Mailing Address - Phone:602-973-6609
Mailing Address - Fax:602-973-0067
Practice Address - Street 1:3650 WEST BETHANY HOME ROAD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85019-1967
Practice Address - Country:US
Practice Address - Phone:602-973-6609
Practice Address - Fax:602-973-0067
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ875111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0083000OtherBCBS
AZZ35WCHHS02Medicare PIN