Provider Demographics
NPI:1841393717
Name:DADIVAS, CORINNE ETHEL (DC)
Entity Type:Individual
Prefix:DR
First Name:CORINNE
Middle Name:ETHEL
Last Name:DADIVAS
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 1:616 S BREA BLVD
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-5307
Mailing Address - Country:US
Mailing Address - Phone:714-686-9704
Mailing Address - Fax:714-256-2220
Practice Address - Street 1:616 S BREA BLVD
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-5307
Practice Address - Country:US
Practice Address - Phone:714-686-9704
Practice Address - Fax:562-245-7760
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 29415111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor