Provider Demographics
NPI:1760540462
Name:DIAMOND, DEBORAH (DC)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:DIAMOND
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:GOLDBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:274 GREAT RD
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-4702
Mailing Address - Country:US
Mailing Address - Phone:978-263-5182
Mailing Address - Fax:
Practice Address - Street 1:274 GREAT RD
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-4702
Practice Address - Country:US
Practice Address - Phone:978-263-5182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2742111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAA10989OtherHARVARD PILGRIM ID NUMBER
MA3116916OtherAETNA ID NUMBER
MAY36902OtherBLUE CROSS OF MA ID NUMBE
MA462097OtherTUFTS ID NUMBER
MA676910OtherCIGNA ID NUMBER
MA0047190OtherNEIGHBORHOOD HEALTH
MA1600516Medicaid
MAAA10989OtherHARVARD PILGRIM ID NUMBER