Provider Demographics
NPI:1609205848
Name:DIECKMANN, ROBYN MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBYN
Middle Name:MARIE
Last Name:DIECKMANN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 S COUNTY FARM RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-2409
Mailing Address - Country:US
Mailing Address - Phone:630-784-8500
Mailing Address - Fax:
Practice Address - Street 1:310 S COUNTY FARM RD
Practice Address - Street 2:SUITE F
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-2409
Practice Address - Country:US
Practice Address - Phone:630-784-8500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-07
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012381111N00000X
PADC010712111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor