Provider Demographics
NPI:1548737174
Name:DIEHL HOLM, BREANNA (DC)
Entity Type:Individual
Prefix:
First Name:BREANNA
Middle Name:
Last Name:DIEHL HOLM
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 1:4178 CENTRAL SARASOTA PKWY APT 335
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34238-6624
Mailing Address - Country:US
Mailing Address - Phone:715-209-7416
Mailing Address - Fax:
Practice Address - Street 1:4678 FRUITVILLE RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-1825
Practice Address - Country:US
Practice Address - Phone:941-379-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-01
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12614111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor