Provider Demographics
NPI:1629126990
Name:GNAT, DIANA LYNN (DC)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:LYNN
Last Name:GNAT
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 1:14208 S MANASSAS LN
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-6070
Mailing Address - Country:US
Mailing Address - Phone:815-293-3952
Mailing Address - Fax:815-293-3953
Practice Address - Street 1:14208 S MANASSAS LN
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-6070
Practice Address - Country:US
Practice Address - Phone:815-293-3952
Practice Address - Fax:815-293-3953
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-008129111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2222583OtherBCBS
IL204475Medicare ID - Type Unspecified
ILU69484Medicare UPIN