Provider Demographics
NPI:1548759145
Name:DIAZ-ROMAN, JOAN (DC)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:DIAZ-ROMAN
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:PO BOX 8918
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-8918
Mailing Address - Country:US
Mailing Address - Phone:215-782-3891
Mailing Address - Fax:215-782-1187
Practice Address - Street 1:1216 E HUNTING PARK AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-4928
Practice Address - Country:US
Practice Address - Phone:267-672-1262
Practice Address - Fax:167-672-1264
Is Sole Proprietor?:No
Enumeration Date:2018-05-09
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADCO11369111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor