Provider Demographics
NPI:1407902851
Name:DIANA, JOSEPH DAVIE (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:DAVIE
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 1:1056 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18202-1707
Mailing Address - Country:US
Mailing Address - Phone:570-455-8141
Mailing Address - Fax:
Practice Address - Street 1:1056 GRANT ST
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18202-1707
Practice Address - Country:US
Practice Address - Phone:570-455-8141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002597L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA104018OtherUNISON
PA805565OtherFIRST PIRIORITY
PA20044653OtherAMERIHEALTHMERCY
PA130905OtherBLUE CROSS BLUE SHIELD
PA2370482OtherAETNA
PA765821OtherFIRST HEALTH
PA001751156001Medicaid
PA104018OtherUNISON
PA130905Medicare ID - Type Unspecified