Provider Demographics
NPI:1467492272
Name:DIEFFENBAUGHER, ERIC ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:ROBERT
Last Name:DIEFFENBAUGHER
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 1:6400 E GALBRAITH RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-2268
Mailing Address - Country:US
Mailing Address - Phone:513-791-5521
Mailing Address - Fax:513-791-5526
Practice Address - Street 1:6400 E GALBRAITH RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-2268
Practice Address - Country:US
Practice Address - Phone:513-791-5521
Practice Address - Fax:513-791-5526
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2843111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDI4084441Medicare ID - Type Unspecified
OHU90520Medicare UPIN