Provider Demographics
NPI:1700417524
Name:LE, DIEM (DC)
Entity Type:Individual
Prefix:
First Name:DIEM
Middle Name:
Last Name:LE
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 1:1100 RIVER OAK DR
Mailing Address - Street 2:
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-7048
Mailing Address - Country:US
Mailing Address - Phone:214-244-2355
Mailing Address - Fax:
Practice Address - Street 1:1996 SCHERTZ PKWY BLDG 5502
Practice Address - Street 2:
Practice Address - City:SCHERTZ
Practice Address - State:TX
Practice Address - Zip Code:78154-1676
Practice Address - Country:US
Practice Address - Phone:210-960-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-30
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13940111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor