Provider Demographics
NPI:1578733598
Name:JONES, DIANE LEE (LIC AC)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:LEE
Last Name:JONES
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 FRANCIS AVE
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-3007
Mailing Address - Country:US
Mailing Address - Phone:508-842-9760
Mailing Address - Fax:
Practice Address - Street 1:386 W MAIN ST
Practice Address - Street 2:SUITE 10A
Practice Address - City:NORTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01532-2128
Practice Address - Country:US
Practice Address - Phone:508-414-8363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA459171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist