Provider Demographics
NPI:1417032657
Name:DIVELBISS, JOHN M (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:DIVELBISS
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 1:3974 BROWN PARK DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-1168
Mailing Address - Country:US
Mailing Address - Phone:614-529-8171
Mailing Address - Fax:614-529-1312
Practice Address - Street 1:3974 BROWN PARK DR
Practice Address - Street 2:SUITE C
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-1168
Practice Address - Country:US
Practice Address - Phone:614-529-8171
Practice Address - Fax:614-529-1312
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH962111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH052103Medicare ID - Type Unspecified
OHT47758Medicare UPIN