Provider Demographics
NPI:1326250416
Name:DIANA, PETER C (DC)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:C
Last Name:DIANA
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 1:3220 LISA TURN
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-1826
Mailing Address - Country:US
Mailing Address - Phone:215-750-0556
Mailing Address - Fax:
Practice Address - Street 1:3220 LISA TURN
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-1826
Practice Address - Country:US
Practice Address - Phone:215-750-0556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2009-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002614L111N00000X
DEF10000303111N00000X
NC1191111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ577398Medicare ID - Type Unspecified
NJT88178Medicare UPIN