Provider Demographics
NPI:1598857575
Name:DIEHL, DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:DIEHL
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 1:2900 TOWNSGATE ROAD
Mailing Address - Street 2:SUITE 212
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-5888
Mailing Address - Country:US
Mailing Address - Phone:805-496-1000
Mailing Address - Fax:805-496-1011
Practice Address - Street 1:2900 TOWNSGATE RD
Practice Address - Street 2:SUITE 212
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-3001
Practice Address - Country:US
Practice Address - Phone:805-496-1000
Practice Address - Fax:805-496-1011
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25686111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0453977Medicaid
IA36033OtherBLUE CROSS BLUE SHIELD
IAI11903Medicare PIN