Provider Demographics
NPI:1689672982
Name:COMO, DIANNE L (DC)
Entity Type:Individual
Prefix:DR
First Name:DIANNE
Middle Name:L
Last Name:COMO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:DIANNE
Other - Middle Name:L
Other - Last Name:COMO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC, PA,
Mailing Address - Street 1:669 WINNETKA AVE N
Mailing Address - Street 2:SUITE 202
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55427-4574
Mailing Address - Country:US
Mailing Address - Phone:763-595-9096
Mailing Address - Fax:763-595-0291
Practice Address - Street 1:669 WINNETKA AVE N
Practice Address - Street 2:SUITE 202
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55427-4574
Practice Address - Country:US
Practice Address - Phone:763-595-9096
Practice Address - Fax:763-595-0291
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3191111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN889027700Medicaid
MN55F13COOtherBCBS
MN889027700Medicaid
MN53213Medicare UPIN