Provider Demographics
NPI:1477710275
Name:DIAMOND CHIROPRACTIC PC
Entity Type:Organization
Organization Name:DIAMOND CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:DIAMOND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-452-0799
Mailing Address - Street 1:518 MONROE TPKE STE A
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:CT
Mailing Address - Zip Code:06468-2358
Mailing Address - Country:US
Mailing Address - Phone:203-452-0799
Mailing Address - Fax:203-452-0405
Practice Address - Street 1:518 MONROE TPKE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:CT
Practice Address - Zip Code:06468-2358
Practice Address - Country:US
Practice Address - Phone:203-452-0799
Practice Address - Fax:203-452-0405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001253111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty