Provider Demographics
NPI:1548210974
Name:MARTIN, DIANA JEAN (DC)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:JEAN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5150 GRAVES AVE
Mailing Address - Street 2:BLDG #7
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-5013
Mailing Address - Country:US
Mailing Address - Phone:408-996-0203
Mailing Address - Fax:408-996-0260
Practice Address - Street 1:5150 GRAVES AVE
Practice Address - Street 2:BLDG #7
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-5013
Practice Address - Country:US
Practice Address - Phone:408-996-0203
Practice Address - Fax:408-996-0260
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20677111N00000X
CADC18718111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor