Provider Demographics
NPI:1528216504
Name:DIEFENBACH, RYAN THOMAS (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:THOMAS
Last Name:DIEFENBACH
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:P.O. BOX 407
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:PA
Mailing Address - Zip Code:19033
Mailing Address - Country:US
Mailing Address - Phone:618-795-6910
Mailing Address - Fax:
Practice Address - Street 1:1308 MACDADE BLVD
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:PA
Practice Address - Zip Code:19033
Practice Address - Country:US
Practice Address - Phone:610-532-0657
Practice Address - Fax:610-532-4258
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008026720111N00000X
PADC011470111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor