Provider Demographics
NPI:1568892172
Name:DIMAGGIO, JOHN (DC, MS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:DIMAGGIO
Suffix:
Gender:M
Credentials:DC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 SW LONGVIEW BLVD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64081-2102
Mailing Address - Country:US
Mailing Address - Phone:816-761-3944
Mailing Address - Fax:866-355-7993
Practice Address - Street 1:400 SW LONGVIEW BLVD
Practice Address - Street 2:SUITE 160
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64081-2102
Practice Address - Country:US
Practice Address - Phone:816-761-3944
Practice Address - Fax:866-355-7993
Is Sole Proprietor?:No
Enumeration Date:2013-11-18
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013039643111N00000X
IL038.012503111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor