Provider Demographics
NPI:1821336967
Name:DIAMOND CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:DIAMOND CHIROPRACTIC LLC
Other - Org Name:DIAMOND SPORT & SPINE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKOMENKO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:302-300-4242
Mailing Address - Street 1:1426 N CLAYTON ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-4006
Mailing Address - Country:US
Mailing Address - Phone:302-300-4242
Mailing Address - Fax:302-300-4241
Practice Address - Street 1:1426 N CLAYTON ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-4006
Practice Address - Country:US
Practice Address - Phone:302-300-4242
Practice Address - Fax:302-300-4241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-24
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF1-0000833111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty