Provider Demographics
NPI:1346319191
Name:CRIVELLI, DIANA JESSICA (DC)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:JESSICA
Last Name:CRIVELLI
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 1:10417 SPRING HILL DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34608-5043
Mailing Address - Country:US
Mailing Address - Phone:352-684-1484
Mailing Address - Fax:352-684-1420
Practice Address - Street 1:10417 SPRING HILL DR
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34608-5043
Practice Address - Country:US
Practice Address - Phone:352-684-1484
Practice Address - Fax:352-684-1420
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8199111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6993Medicare ID - Type Unspecified
FLU94595Medicare UPIN