Provider Demographics
NPI:1578625323
Name:JATIVA, DIEGO FERNANDO (DC)
Entity Type:Individual
Prefix:
First Name:DIEGO
Middle Name:FERNANDO
Last Name:JATIVA
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 1:2467 E SEMORAN BLVD
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-5806
Mailing Address - Country:US
Mailing Address - Phone:407-814-0985
Mailing Address - Fax:407-814-0119
Practice Address - Street 1:535 S CHICKASAW TRL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-7801
Practice Address - Country:US
Practice Address - Phone:407-277-1031
Practice Address - Fax:407-277-5556
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7151111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL197020OtherCHIRO ALLIANCE CORP.
FL109233OtherAMERIGROUP
FL53968OtherBLUE CROSS BLUE SHIELD
FL7443014OtherAETNA
FL9705808OtherCIGNA
FL381779200Medicaid
FL53968OtherBLUE CROSS BLUE SHIELD