Provider Demographics
NPI:1679115042
Name:LOUCA, DIANA
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:LOUCA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 MOUNTAINVIEW RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-4730
Mailing Address - Country:US
Mailing Address - Phone:609-744-3912
Mailing Address - Fax:
Practice Address - Street 1:6921 FRANKFORD AVE STE A
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19135-1623
Practice Address - Country:US
Practice Address - Phone:609-744-3912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-17
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008736111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor