Provider Demographics
NPI:1710150107
Name:DIANE L MICHAELS DC PA
Entity Type:Organization
Organization Name:DIANE L MICHAELS DC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR. DIANE L. MICHAELS
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MICHAELS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:941-761-0210
Mailing Address - Street 1:501 VILLAGE GREEN PKWY
Mailing Address - Street 2:SUITE 15
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-3404
Mailing Address - Country:US
Mailing Address - Phone:941-761-0210
Mailing Address - Fax:941-795-0708
Practice Address - Street 1:501 VILLAGE GREEN PKWY
Practice Address - Street 2:SUITE 15
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-3404
Practice Address - Country:US
Practice Address - Phone:941-761-0210
Practice Address - Fax:941-795-0708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006891111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10715738OtherCAQH
FL=========OtherTIN