Provider Demographics
NPI:1689972671
Name:DIETRICK, CHERYL LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:LYNN
Last Name:DIETRICK
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 1:193 BLUE RAVINE RD STE 245
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-4767
Mailing Address - Country:US
Mailing Address - Phone:916-989-1014
Mailing Address - Fax:916-989-1461
Practice Address - Street 1:193 BLUE RAVINE RD STE 245
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-4767
Practice Address - Country:US
Practice Address - Phone:916-989-1014
Practice Address - Fax:916-989-1461
Is Sole Proprietor?:No
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19098111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor